Insurance Pharmacist

My Clinic KSA; Jeddah; On-site; SAR 120,000 - 150,000; Full time

Job summary

A leading healthcare provider in Saudi Arabia is seeking a Pharmacy Support Specialist in Jeddah. You will assist pharmacists with insurance queries, manage pre-authorization requests, and ensure patient understanding of coverage. The ideal candidate will have a Bachelor's in pharmaceutical sciences and two years of relevant experience, along with an insurance foundation certificate.

Qualifications

• Minimum of two years’ experience in pharmacy or insurance-related field.
• Possess an insurance foundation certificate.

Responsibilities

• Assist with insurance queries and processes.
• Follow up on rejected pre-authorization requests.
• Communicate with insurance providers for approvals.
• Train pharmacists on insurance details.

Skills

Insurance policy understanding

Patient communication

Data analysis

Education

Bachelor's degree in pharmaceutical sciences

Job description

Join My Clinic, the leading multispecialty outpatient care provider in Saudi Arabia, where our mission is to help people live longer, healthier, and happier lives. Since 2017, we've been at the forefront of healthcare, combining innovation with a deep commitment to care, collaboration, ambition, and responsibility. As we continue to grow and reach new heights, we're looking for passionate individuals who share our vision and values.

Job Description:

1. Work as a back-line support with pharmacists to assist with insurance queries.
2. Follow up on rejected pre-authorization requests and process them to obtain approval if covered by CHI policy and medically justified.
3. Communicate directly with insurance companies’ doctors and delegates to gain approval for medications.
4. Manage and handle missed pre-authorization requests.
5. Stay updated with new insurance company policies and medical guidelines to apply exceptions or additional rules, facilitating faster decision-making and approval processes.
6. Assist patients in understanding their insurance coverage and address related queries.
7. Update the list of non-covered medications according to CHI's new rules and insurance policies.
8. Update the drug formulary classification according to the latest IDF of SFDA drug list to correctly implement the new deductible policy of CHI.
9. Train frontline pharmacists and keep them updated about insurance details.
10. Perform data analysis on rejected medications to identify and reduce rejection reasons in future claims.
11. Perform other professional duties as requested by the line manager.

Education / Professional Qualifications:

1. Bachelor's degree in pharmaceutical sciences.
2. Minimum of two years’ experience in the same field.
3. Insurance foundation certificate.