Fraud, Waste, and Abuse Program Manager - Extended Health Care Pharmacy Included

The Fraud, Waste and Abuse (FWA) team mandate is to drive business value for clients by developing and using highly innovative and effective audit and investigation techniques to detect and address risk, ensuring the integrity of health, dental and extended healthcare (EHC) claims while maintaining a superior network of providers through diligent review, education and adherence protocols.

Reporting to the Senior Manager - FWA and HCA, the EHC and FWA Program Manager will be responsible for managing the relationships with ESC clients and delivering FWA services of the highest quality. This includes contributing to FWA team objectives to meet and exceed client value expectations and be recognized as knowledge experts in healthcare FWA. This position will lead a team comprised of various roles to support program development, alignment across various FWA teams, govern change management and support delivery of superior quality FWA services to ESC clients. This role is also required to drive and participate in strategic planning activities for the FWA program as well as supporting new business activities by actively participating in sales presentations and assisting with responses to quotes. This job should directly contribute to building a high-performance culture and living the Cigna values.
ESSENTIAL FUNCTIONS:

Responsible for the development and ongoing maintenance of the FWA Program standards and procedures, in keeping with provincial provider regulations and practices.

Support communication protocols with providers and clients to achieve response and resolution of FWA related issues.

Organizing and representing ESC at private and public sector customer meetings related to FWA.

Takes a lead role in the design and building phase of high complexity business applications to ensure quality systems produce the desired results.

Support the evaluation of products against business specifications to determine optimum solution for the organization.

Facilitate change management and implementation by leading local projects that fall within the larger scope of the business and strategic planning.

Accountability for managing resources that support reporting, budgeting and forecasting processes

Represent ESC on committees/associations such as CHLIA as required

Responsible for managing the execution of FWA extended healthcare service delivery within service standards

Lead and engage the FWA Audit Program team in achieving corporate and department strategic goals/objectives and develop initiatives aligned with these objectives to maximize best outcomes

Foster a people first culture that develops the skills and capabilities of team members to enable personal and business growth

Ensure that team members are effectively trained and are provided with the appropriate tools, including evergreen process documentation, to reach success in their roles

Work cross functionally with ESC teams to enable best holistic outcomes for the organization

Support the identification and review of challenging areas within the FWA team and provide recommendations to leaders to ensure consistent delivery of their services with quality and on time

QUALIFICATIONS

University degree or equivalent

Valid license to practice pharmacy in Canada

Minimum 5 years of experience practicing as a pharmacist

Strong leadership and management skills

Experience in healthcare insurance and/or benefit industry including provider practice regulations and familiarity with provider software systems

Ability to work effectively with internal and external clients

Excellent time and resource management skills.

Proven ability to manage multiple high priority tasks in a fast-paced and evolving organization.

Excellent interpersonal skills to facilitate change management.

Experience identifying trends and process gaps, analyzing information, recommending, developing and implementing creative and effective solutions and providing strategic input.

Must be team and detail oriented.

Excellent critical thinking and analytical skills and verbal and written communication skills

Self-starter able to work in a dynamic environment and make independent decisions

Proven experience in applying agile principles and practices when executing on deliverables

Knowledge of computer applications (Word, Excel, PowerPoint)