Overview
PBM Pre-Approval Officer Jobs in Ajman at Medstar Healthcare LLC
AccuMed, is actively Hiring for the role of PBM Pre-Approval Officer to be based in Ajman for a Government Hospital.
Interested candidates who meets the below mentioned criteria can send your CV here.
Kindly Note: Carefully read the Job requirements before applying as only candidates who meet the below mentioned criteria will be contacted for an Interview. Immediate joiner preferred.
Job Summary
We are seeking a detail-oriented PBM Pre-Approval Officer to manage medication prior authorization requests within a Pharmacy Benefit Management (PBM) environment. The role involves reviewing prescriptions, verifying insurance coverage, and ensuring compliance with payer guidelines to facilitate timely approvals and optimal patient care.
Key Responsibilities
- Review and process pre-authorization requests for medications in line with payer policies and clinical guidelines
- Verify patient eligibility, insurance coverage, and prescription details
- Coordinate with physicians, pharmacies, and insurance providers to obtain required documentation
- Ensure accurate and timely approvals, rejections, or escalations based on medical necessity
- Maintain compliance with UAE healthcare regulations and insurance requirements
- Monitor turnaround times and ensure SLAs are consistently met
- Document all approvals, denials, and communications in the system
- Handle queries and escalations from providers, pharmacies, and internal stakeholders
- Identify trends in denials and recommend process improvements
Requirements
- Bachelor’s or Master’s in Pharmacy
- 2–3 years of experience in PBM, insurance, or healthcare pre-authorization roles
- Strong understanding of medication approval workflows, insurance policies, and clinical guidelines
- Familiarity with UAE healthcare insurance systems is preferred
- Good knowledge of medical terminology and drug classifications
- Strong attention to detail and analytical skills
- Excellent communication and coordination abilities
Preferred Qualifications
- Pharmacist background or DHA/MOH/DOH license (preferred but not mandatory)
- Experience working with PBM systems and Riyaati claims platforms
Job Types: Full-time, Permanent
Pay: AED5,000.00 – AED5,500.00 per month
Work Location: In person
Title: PBM Pre-Approval Officer
Company: Medstar Healthcare LLC
Location: Ajman
