• Job Description

  Req#: 25016949

  Job Title: Audit Claims Investigator

  Location: British Columbia
  Employment Type: Full-time

  Reason for Vacancy: New Headcount

  Work Arrangement: Remote, Work at home
  Department Name: Fraud, Waste and Abuse

  Pay Type: Salaried

  Pay Range: $63,000 - $67,000 annually.

  Please note that this is a general posting range and offer range will be varied based on relevant experience, qualifications, skills required and location for this role.

  About Us

  Express Scripts Canada (ESC) is the leader in health benefits management. Serving over 12 million members, we help insurance carriers, third party administrators, and the public sector optimize the value of health benefits by linking the talent and professional expertise of our people with leading edge information management systems and technology. Express Scripts Canada is a wholly owned subsidiary of Express Scripts, one of the largest pharmacy benefit management (PBM) companies in North America , part of The Cigna Group (NYSE: CI), a global health company . Together, we deliver innovative, cost-effective solutions that improve access, affordability, and health outcomes for Canadians

  Job Summary:

  Reporting to the FWA Pharmacy Manager, the Audit Claims Investigator is responsible for identifying and investigating pharmacy providers, plan members, and prescribers for fraud, waste, and abuse risks associated with ESC’s clients. Using critical thinking skills and data analytics, the incumbent will complete complex investigational audit reviews in order to correct risks identified and protect client’s health benefit plan assets, and present findings both verbally and in writing to key internal and external stakeholders. In addition, the Claims Investigator will participate in identifying and recommending policy, procedures, and systems changes to enhance case development efficiency and quality of cases.

  Note: Due to operational requirements and the nature of the role, candidates must reside in the province of British Columbia. This position requires nationwide travel as needed for physical on-site inspection.

  Key Responsibilities

  • Analyze and evaluate potential fraud and abuse situations using corroboratory information obtained through correspondence with members, physicians, and pharmacies.

  • Identify and investigate cases of suspected fraud and high abuse for assigned clients. Develop these cases in compliance with any applicable policies, procedures, or regulatory requirements.

  • Prepare formal and thorough written reports to upper management and clients, expressing the findings of completed investigations.

  • Prepare for and take a lead role in client communications, including conference calls and on-site meetings, to present status updates of ongoing issues, results of completed investigations, etc., for assigned clients.

  • Manage fraud tips (through emails, fraud tip line, client referrals, etc.). Track and monitor the status of each investigation.

  • Conduct desk and physical on-site inspections.

  • Attend industry‑related anti‑fraud meetings or conferences as required.

  • Work with the Data Analytics team to enhance profiling and fraud reporting requirements based on emerging risks.

  • Support internal initiatives and projects as assigned.

  What We’re Looking For:

  • Bachelor’s degree or equivalent work experience.

  • 2–5 years of relevant experience as a pharmacy technician, health care professional, or data analyst.

  • Certified Pharmacy Technician, Certified Fraud Examiner, or similar certification strongly desired.

  • Highly proficient in Microsoft Access & Excel, and data‑warehousing applications.

  • Excellent organizational and interpersonal skills, critical thinking and planning skills, verbal and written communication skills, including the ability to present to clients and internal stakeholders.

  • Ability to travel nationwide as needed for physical on-site inspections.

  • Ability to work well with senior management and high‑level external contacts, handle sensitive or confidential information which is critical, and work with minimum management oversight on multiple projects with competing priorities.

  • Ability to work a flexible schedule to accommodate project deadlines.

  Why Join Us?

  • Competitive compensation, benefits and pension plan

  • Career development and advancement opportunities

  • A culture that celebrates innovation and collaboration

  • Flexible work options and wellness programs

  Pre-Employment Requirements

  All offers of employment are conditional upon the successful completion of reference checks and background verification in accordance with company policy. Within ESC, for certain positions, obtaining and maintaining a federal government security clearance is a condition of employment. Candidates applying for such roles must meet all eligibility criteria for the applicable clearance level and consent to the security screening process as mandated by federal regulations. Failure to obtain or maintain the required clearance will result in withdrawal of the offer or termination of employment.

  Our hiring process includes AI-powered tools to conduct video interviews, take notes and score candidates; however, all scores will be reviewed by hiring managers and our Talent team before making a decision.

  NOTE: Internal candidates should apply before February 13 , 2026.

  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: eschr2@express-scripts.com Do not email eschr2@express-scripts.com for an update on your application or to provide your resume as you will not receive a response.

• About the company

  Cigna is an American worldwide health services organization based in Bloomfield, Connecticut.

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