Baldeep Kaur Shetra
Brampton,Canada
Summary
Dynamic Reimbursement Specialist at ESI Canada with expertise in pharmacy claim auditing and fraud detection. Proven ability to analyze complex datasets and enhance patient service through effective collaboration. Skilled in regulatory compliance and stakeholder communication, driving successful outcomes in reimbursement access and operational efficiency.
Overview
14
14
years of professional experience
Work History
Reimbursement Specialist
ESI Canada
Mississauga, Ontario
11.2025 - Current
- Contacted patients on behalf of other carriers to relay information regarding recent requests.
- Engaged in interdepartmental collaboration to streamline processes and improve patient service.
- Maintained confidentiality and integrity of patient data.
- Identified opportunities for coverage access to address reimbursement barriers.
- Treated patients as warm leads to facilitate enrollment with preferred pharmacies.
Pharmacy Claim Auditor
ESI Canada
Mississauga, Ontario
04.2023 - 11.2025
- Conduct detailed audits of pharmacy claims to identify fraud, waste, and abuse in alignment with benefit plan rules and regulatory standards.
- Analyze large datasets to detect unusual billing patterns, investigate anomalies, and produce actionable audit reports.
- Collaborate with compliance and legal teams to escalate issues and support recovery efforts.
- Maintain working knowledge of drug programs (e.g. ODB, NIHB, private insurers) and adjudication systems.
- Completed comprehensive internal training on pharmacy benefits, audit methodology, and fraud detection tools.
- Note: Took a brief maternity leave during tenure and resumed full auditing responsibilities upon return.
Registered Pharmacy Technician
Oakville Trafalgar Memorial Hospital
Oakville, Canada
06.2021 - 04.2023
- Prepared, packaged, and dispensed medications in compliance with hospital policies.
- Conducted sterile compounding and collaborated with interdisciplinary care teams to ensure timely drug delivery.
Pharmacy Technician
Trillium Health Partners
Mississauga, Canada
02.2020 - 06.2021
- Supported inpatient pharmacy services with a focus on IV compounding and medication order fulfillment.
Pharmacy Technician
Humber River Hospital
Toronto, Canada
05.2018 - 06.2021
- Worked across emergency, surgical, and inpatient units to support pharmacy operations and safe medication use.
Pharmacy Technician (Contract)
The Hospital for Sick Children (SickKids)
Toronto, Canada
02.2019 - 02.2020
- Assisted in pediatric medication preparations, sterile IV formulations, and pharmacy workflow in a high-volume children's hospital.
Pharmacy Assistant → Pharmacy Technician
Bramcenter Pharmacy
Brampton, Canada
10.2011 - 05.2018
- Gained foundational experience in retail pharmacy operations, including third-party billing and patient care support.
- Progressed to licensed Pharmacy Technician during tenure.
Education
Pharmacy Technician Licensing - Pharmacy
OCP
11-2017
Pharmacy Technician Diploma - Pharmacy
Sheridan College
Brampton, ON09-2013
Skills
- Pharmacy and health claim auditing
- Fraud, waste, and abuse investigation
- Drug benefit plan analysis
- Clinical drug use understanding
- Data review and pattern detection
- Microsoft Excel and audit tools
- Kroll and EMR systems
- Regulatory compliance expertise
- Stakeholder communication and collaboration
Professional Development
- Internal FWA & Compliance Audit Training - ESI Canada
- OCP Continuing Education Courses
- Excel for Auditors - Intermediate Level
Timeline
Reimbursement Specialist
ESI Canada
11.2025 - Current
Pharmacy Claim Auditor
ESI Canada
04.2023 - 11.2025
Registered Pharmacy Technician
Oakville Trafalgar Memorial Hospital
06.2021 - 04.2023
Pharmacy Technician
Trillium Health Partners
02.2020 - 06.2021
Pharmacy Technician (Contract)
The Hospital for Sick Children (SickKids)
02.2019 - 02.2020
Pharmacy Technician
Humber River Hospital
05.2018 - 06.2021
Pharmacy Assistant → Pharmacy Technician
Bramcenter Pharmacy
10.2011 - 05.2018
Pharmacy Technician Licensing - Pharmacy
OCP
Pharmacy Technician Diploma - Pharmacy
Sheridan College