Claims Specialist

McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare. We are known for delivering insights, products, and services that make quality care more accessible and affordable. Here, we focus on the health, happiness, and well-being of you and those we serve - we care.

What you do at McKesson matters. We foster a culture where you can grow, make an impact, and are empowered to bring new ideas. Together, we thrive as we shape the future of health for patients, our communities, and our people. If you want to be part of tomorrow's health today, we want to hear from you.

Company Profile

McKesson Corporation is a global leader in healthcare supply chain management solutions, retail pharmacy, community oncology and specialty care, and healthcare information solutions. McKesson partners with pharmaceutical manufacturers, providers, pharmacies, governments, and other organizations in healthcare to help provide the right medicines, medical products, and healthcare services to the right patients at the right time, safely and cost-effectively.

United by our I2CARE shared principles, our employees work every day to innovate and deliver opportunities that make our customers and partners more successful - all for the better health of patients. McKesson has been named a "Most Admired Company" in the healthcare wholesaler category by FORTUNE, a "Best Place to Work" by the Human Rights Campaign Foundation, and a topmilitary-friendly companyby Military Friendly. For more info, visitwww.mckesson.com.

We take pride in our culture of connection and believe in a workplace where everyone can be their full, authentic self. We welcome and encourage veterans, individuals with disabilities and others with diverse perspectives to join our growing team. Your unique perspective and experience are valuable assets that can translate into a rewarding career path with us.

Position Description

McKesson is seeking aClaims Specialist.

The Claims Specialist at Biologics, is responsible for efficiently and accurately processing and resolving claims issues, ensuring compliance with company policies and industry regulations. This role involves direct interaction with healthcare providers, patients, and insurance carriers to facilitate timely and appropriate claim settlements.

Key Responsibilities

• Review and adjudicate claims for completeness, accuracy, and compliance with payer and internal guidelines.

• Investigate escalated claims issues, including reversals, unbilled shipments, and finance discrepancies.

• Collaborate with finance and operations teams to ensure claims are payable and properly documented.

• Track and follow up on DAR (dispense after review) claims and coordinate with finance for resolution.

• Maintain detailed records of claim decisions, actions taken, and communications.

• Identify trends in claim denials or delays and recommend process improvements.

• Support user acceptance testing (UAT) for claims-related systems and enhancements.

• Join cross-functional meetings to coordinate claims data integration and reporting.

• Ensure compliance with HIPAA, CMS, and other regulatory requirements.

Education & Minimum Requirements

• Bachelor's degree in a relevant field (e.g., Healthcare Admin, Business, Finance) or equivalent work experience.

• Typically requires 2+ years of relevant experience.

Critical Skills

• Minimum of 2 years of experience in medical/pharmacy claims processing, preferably within the biotechnology or pharmaceutical industry.

• In-depth knowledge of medical terminology, CPT, ICD-10, and HCPCS coding.

• Strong understanding of various insurance plans, including commercial, Medicare, and Medicaid.

• Proven ability to interpret and apply insurance policies and regulations.

• Excellent communication (written and verbal), interpersonal, and negotiation skills.

• Strong analytical and problem-solving abilities with keen attention to detail.

• Proficiency in claims management software and Microsoft Office Suite (Excel, Word, Outlook).

• Ability to work independently and as part of a team in a fast-paced environment.

• Demonstrated commitment to patient privacy and data security.

Additional Skills

• Demonstrate initiative.

• Diligence and proven organizational skills.

• Demonstrated ability to communicate insights effectively.

• Ability to prioritize and meet deadlines.

• Ability to work in a self-motivated environment.

• Collaborative, customer focused, and able to create value for clients.

• Ability to solve problems and think critically to effectively resolve issues.

• Ability to ensure operational and administrative compliance with regulations, standards, procedures, laws, rules,and statutes.

Specialized Knowledge/Skills

• Knowledge of the insurance or healthcare market; reimbursement and pricing models, experience, and knowledge of compliance activity in heavily regulated industry.

• Demonstrated analytical skills and the ability to identify trends in large amounts of data, as well as the ability to communicate insights effectively.

Working Conditions

• Able to travel domestically 5% of the time.

• Ideally located in North Carolina (Cary/Raleigh) or in Fort Worth, Texas.

• Hybrid work environment - Will work in the office 1 day a week (*Wednesdays).

• Must be authorized to work in the US unrestricted - This position is not eligible for sponsorship.

We are proud to offer a competitive compensation package at McKesson as part of our Total Rewards. This is determined by several factors, including performance, experience and skills, equity, regular job market evaluations, and geographical markets. The pay range shown below is aligned with McKesson's pay philosophy, and pay will always be compliant with any applicable regulations. In addition to base pay, other compensation, such as an annual bonus or long-term incentive opportunities may be offered. For more information regarding benefits at McKesson, pleaseclick here.

Our Base Pay Range for this position

McKesson is an Equal Opportunity Employer

McKesson provides equal employment opportunities to applicants and employees and is committed to a diverse and inclusive environment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, age or genetic information. For additional information on McKesson's full Equal Employment Opportunity policies, visit our Equal Employment Opportunity page.

Join us at McKesson!