We are seeking a highly skilled and experienced Manager, Pharmacy Benefits & Claims to lead our client's claims management team within the pharmaceutical and healthcare benefits industry. This role requires deep expertise in drug reimbursement, specialty medications, and patient support programs, ensuring that pharmacy benefits are managed effectively in alignment with industry regulations and trends. The ideal candidate will bring strong leadership in pharmacy benefits management, knowledge of high-cost drugs and provincial drug programs, and a strategic approach to optimizing claims processes.

Roles and Responsibilities

• Oversee the management of pharmacy benefits, ensuring compliance with provincial and federal drug programs.
• Lead, mentor, and develop a team of claims professionals specializing in drug reimbursement and specialty medications.
• Develop and implement strategies to enhance drug claims adjudication and improve cost management for specialty drugs.
• Monitor KPIs to assess team performance and identify opportunities for improvement.
• Collaborate with pharmaceutical manufacturers, pharmacy benefit managers (PBMs), and healthcare providers to optimize claims processing and patient access to medications.
• Stay ahead of industry trends, regulatory changes, and pricing strategies for high-cost drugs, ensuring the organization remains competitive.
• Work closely with underwriting, marketing, product innovation, and operations to align pharmacy benefits strategy with business goals.
• Support fraud detection efforts by identifying irregularities in drug reimbursement claims and working with investigative teams to mitigate risks.

Qualifications and Skills

• Minimum of 5-7 years of experience in pharmacy benefits management, pharmaceutical industry, or drug policy administration.
• Strong knowledge of provincial drug programs (e.g., RAMQ), patient support programs, and specialty medication reimbursement.
• Proven ability to lead and develop high-performing teams.
• Experience working with pharmacy benefit managers (PBMs), insurers, and regulatory bodies.
• Strong analytical skills with the ability to assess data, interpret drug policy changes, and drive improvements.
• Exceptional communication and interpersonal skills to engage with stakeholders across the pharmaceutical and insurance industries.
• Proficiency in claims management systems and pharmacy benefits technology.
• Bilingualism (French/English) is an asset, especially for working with Quebec’s RAMQ program

Education

• Bachelor’s degree in business administration, healthcare management, or a related field.

Benefits

• 12% bonus 
• 4 weeks vacation
• Pension
• Extended health benefits

Why Should you Join?

• Opportunity to lead and shape a high-performing pharmacy benefits team in a dynamic and evolving industry.
• Competitive compensation and benefits package.
• A collaborative and inclusive workplace culture.
• Professional development opportunities to enhance your leadership and pharmaceutical industry expertise.