Express Scripts Canada’s (ESC) Provider Relations department is responsible for maintaining a robust network of healthcare providers (pharmacies, dental providers and extended health care providers) to support the integrity of healthcare claims adjudicated by ESC on behalf of ESC clients. Participating healthcare service providers submit electronic and paper claims to ESC on behalf of their patients which are plan members of ESC’s insurance, Third Party Administration and Government clients. Provider management services include managing healthcare provider contracts, the registration of providers across Canada, the maintenance of the ESC provider database as well as communication with these same providers.
Reporting to the Director of Operations, the Senior Provider Relations Manager will provide strategic leadership that will continuously elevate provider management services to optimize the value for internal and external ESC clients as well as to participating healthcare service providers and stakeholders. Central to the value proposition for the Provider Relations team is on-going communication with a variety of parties including healthcare provider associations, provincial colleges, pharmacy chains, software vendors, third party suppliers and internal and external clients to ensure awareness of ESC policies, billing and remittance support, execution of administrative tasks related to provider contracts and provider registration, provider website support and maintenance of the ESC provider database to ensure up to date and accurate provider information. ESC is looking for a dynamic candidate with proven operational experience to accelerate cross functional teamwork, operational excellence, people development, change management, client service and innovation.
- Develop vision and strategy for the Provider Relations team that aligns with corporate and operations strategic goals and objectives
- Lead and engage the Provider Relations team in achieving corporate and department strategic goals/objectives and develop initiatives aligned with these objectives to maximize best outcomes
- Establish and maintain professional relationships with healthcare providers and associations as required to provide support, resolve issues and provide ongoing education on ESC policies
- Ensure quality communication with healthcare providers, associations, provincial colleges, pharmacy chains, software vendors, third party suppliers and internal and external clients
- Effectively manage and forecast team budgets to support ESC financial goals
- Develop and maintain monitors and controls to maximize ability to meet service standards and objectives for turnaround time and quality
- Ensure the development and on-going review of monthly operational reports and visual dashboards to ensure visibility on current status of service delivery and insights on trends and patterns
- Develop, monitor and assess key performance indicators to support data driven decisions in mitigating risk and exploring opportunities to streamline, automate and improve existing services
- 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
- Partner with applicable business leaders and legal to ensure that provider contracts and provider manuals are aligned with ESC strategy and both client and ESC business needs and dependencies
- Ensure the coordination of system testing with software vendors to ensure that their software complies with the correct adjudication methods
- Participate in client meetings as required and develop strategies to ensure/increase client satisfaction
- Support ad hoc projects including request for proposals as required
- Bachelor’s degree, or equivalent work experience
- Minimum of 5 years operational experience with demonstrated people leadership capabilities and business outcomes
- Ability to demonstrate leadership through effective mentoring and coaching staff to achieve results and a build/maintain a high performance culture
- Excels at fostering cross functional teamwork and partnerships
- Self-starter able to work in a dynamic, fast paced environment and make independent decisions
- Proven skills in time management, planning, prioritization, resiliency and employee performance management
- Strong client service focus through adaptability, flexibility and a commitment to quality
- Excellent verbal and written communication skills
- Change management skill and experience
- Highly proficient in MS Office (knowledge of Excel, Word and PowerPoint required)
- Limited travel will be required
- Background in managing communications and operational management and oversight
- Experience in Group Benefits and/or Pharmacy Benefit Management
- Bilingualism (English and French)
Express Scripts Canada is a Cigna company
Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company. Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.
About Express Scripts Canada
Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada’s leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. We provide Active Pharmacy™ services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually. Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.
It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation to receive clearance if required.
We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.
We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.
We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.
If you require accommodation in completing the online application process, please email: [email protected] Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.