Claims Process Specialist, Specialized Distribution

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Job Summary

The MSD Claims Process Specialist is responsible for leading and optimizing the end-to-end claims process within Specialized Distribution including claims complaints and return requests. This role combines hands-on operational execution with process ownership to ensure timely investigations accurate credit processing effective issue resolution and compliance with client contractual obligations. Operating with a high degree of autonomy the incumbent also manages complex and escalated claims monitors trends and performance provides high-quality customer support and delivers recommendations analytics and process improvements to strengthen decision-making and overall team effectiveness. The role also represents the function on client calls as a subject matter expert providing operational insight clarifying process requirements and supporting issue resolution.

Specific Responsibilities

• Lead the end-to-end claims process including intake investigation validation resolution credit processing and closure.

• Manage complex high-value and sensitive claims serving as the primary escalation point and ensuring timely accurate resolution.

• Exercises independent judgment in claims validation resolution approach and escalation decisions.

• Ensure compliance with internal SOPs client contractual requirements and applicable regulatory expectations.

• Partner with cross-functional stakeholders including Customer Care Finance Quality Operations and clients to resolve issues efficiently and support strong service outcomes.

• Analyze claims complaints and return trends to identify root causes improve turnaround time and drive corrective and preventive actions.

• Develop maintain and report key performance indicators service levels and operational metrics to support performance monitoring and decision-making.

• Prepare metrics present results and action plans during client business reviews and represent the claims function on client calls as a subject matter expert.

• Maintain accurate manufacturer return policies and provide guidance to optimize returns-related processes and team execution.

• Support Order-to-Cash and product returns workflows by monitoring performance identifying improvement opportunities and strengthening outcome measurement.

• Lead and support continuous improvement initiatives including process standardization documentation system enhancements and implementation of new tools workflows and pilots.

• Provide guidance and informal leadership to team members handling claims-related activities while fostering knowledge sharing and consistency of execution.

• Maintain current knowledge of relevant product categories industry trends and business conditions while acting as an ambassador of McKessons corporate values.

Qualifications

Working Experience

• Experience in pharmaceutical environment (3PL distribution experience an asset).

• Retail/Wholesale/Hospital supply chain and procurement management experience an asset.

• Experience managing client relationships in a service-based environment

• Experience with data analytics and database/systems management.

Education

• University degree in relevant discipline.

Personal Development and Soft Skills

• Strong analytical and problem-solving skills.

• Strong attention to details

• Demonstrated leadership.

• Excellent partnering skills.

• Excellent communication and presentation skills.

• Ability to collaborate with various levels of management and employees.

• Ability to multi-task working proactively and independently in a fast-paced dynamic environment.

Technical Skills

• Bilingual both written and spoken.

• Extensive knowledge of MS Office products (Power Point Excel Word Project Visio and PowerBI).

• Knowledge of S&OP an asset.

Other Skills and Capabilities

• Strong business and accounting acumen.

• Client-focused; solutions oriented.

• Ability to work as part of multi-functional teams.

• Regulatory awareness.

• Attention to detail whilst maintaining a strong sense of summary and ability to synthesize.

• Ability to identify operational and strategic issues and proactively drive solutions.

• Available for travel (less than 4 trips per year with potential overnight stay).

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