Claims Auditor I-THPS
TELUS Communications
Toronto, ON
Reporting to the Manager of Audit, the Claims Auditor is responsible for conducting claims audits on behalf of our customers to validate claims submitted by providers and ensure their compliance to the terms and conditions set out in the provider agreement. Auditor will typically specialize in one particular line of business (i.e. drug vs. dental).

Conduct various types of audits including desk, cardholder, on-site, compounds and mailers, Open-windows
Gather and compile data from multiple sources including providers, cardholders, physicians and dentists
Complete investigation and report on findings
Process adjustments and reversals on the transactions as required
Maintain complete and accurate documentation of all audit related information, reports and conversations
Manage multiple assignments at one time and provide back up support to other auditors
Provide basic technical support to Insurance Companies, Providers, Help Desk and other teams in Client Services
Contribute to achieving team objectives and delivery on service level commitments including all SLA’s

Required Knowledge, Skills & Abilities:
Knowledge of business flows in claims management and submission: Working Knowledge
LOMA, CEBs, ICA, HIAA training would be an asset: Working Knowledge
Knowledge of Microsoft Office and Network systems: Intermediate
Knowledge of pharmacy, dental, Extended Health and/or audit practices: Working Knowledge
Ability to manage confidential information and protect privacy: Intermediate
Performs well under pressure and demonstrates effective time management skills; ability to effectively multitask: Intermediate
High school completion
1-3 years Pharmacy experience