Senior Pharmacy Claims Adjudication Executive

métier - Strategic HR Solutions; Dubai; On-site; AED 201,000 - 312,000; Full time

Job summary

métier - Strategic HR Solutions is seeking a qualified pharmacy professional to support accurate and timely claims decisions for a leading client in the UAE. The role focuses on adjudicating outpatient pharmacy claims, reviewing pre-authorizations, and coordinating with providers and insurers to ensure compliant decisions. Requirements include a B.

Pharm or Pharm. D. from a recognized institution, UAE-licensure or eligibility, and 3–5 years experience in pharmacy or insurance adjudication.

Qualifications

• Experience in pharmacy claims adjudication and medical coding.
• Strong understanding of UAE health insurance and pharmacy regulations.
• Excellent analytical, documentation and attention-to-detail skills.

Responsibilities

• Review and adjudicate outpatient pharmacy claims for medical necessity, eligibility, and policy coverage.
• Verify prescriptions, medicines, dosage, quantity, formulary status, limits, and applicable policy terms.
• Identify duplicate, inappropriate, excessive, or potentially fraudulent pharmacy claims.
• Apply policy terms, medical guidelines, formularies, and insurer rules.

Skills

Pharmacy claims adjudication

Medical coding

Policy interpretation

Analytical skills

Documentation

Education

B. Pharm / Pharm. D. from a recognized institution

Job description

métier - Strategic HR Solutions is seeking a qualified pharmacy professional to support accurate and timely claims decisions for a leading client in the UAE. The role focuses on adjudicating outpatient pharmacy claims, reviewing pre-authorizations, and coordinating with providers and insurers to ensure compliant decisions. Requirements include a B.

Pharm or Pharm. D. from a recognized institution, UAE-licensure or eligibility, and 3–5 years experience in pharmacy or insurance adjudication.