Pharmacy Insurance & Prior Authorization Executive

Why This Role Matters

In modern healthcare systems, timely access to medication depends not only on clinical accuracy but also on efficient insurance coordination and regulatory compliance. Delays in insurance verification, prior authorization approvals, or claim processing can directly impact patient treatment outcomes and satisfaction.

The Pharmacy Insurance & Prior Authorization Executive role at Zulekha Hospital LLC plays a crucial role in ensuring seamless medication access while minimizing financial burden on patients. By verifying eligibility, managing prior authorizations, resolving claim denials, and maintaining PBM compliance, this position strengthens both patient care delivery and revenue cycle efficiency.

This role is ideal for professionals with pharmacy or healthcare administration backgrounds who have experience handling insurance processes within hospital or pharmacy environments.

Job Description

Zulekha Hospitals, UAE (JCI Accredited and Winner of the Dubai Quality Award), is one of the largest healthcare providers in the region. With two multi-disciplinary hospitals in Sharjah and Dubai, four medical centers, and three pharmacies, the organization delivers high-quality healthcare services supported by advanced diagnostic facilities and super specialty units including Cardiac Care, ICU, and NICU.

The hospital is currently seeking a skilled Pharmacy Insurance & Prior Authorization Executive to manage insurance verification, prior authorization processing, PBM compliance, and billing resolution processes within its pharmacy operations. The selected candidate will ensure accurate insurance coordination while maintaining regulatory compliance and high service standards.

Key Features of the Role

Direct involvement in patient access and insurance coordination processes.
Exposure to PBM policies and healthcare insurance regulations.
Opportunity to work in a JCI-accredited healthcare environment.
Engagement with cross-functional teams including pharmacists, physicians, and billing departments.
Contribution to reducing claim denials and improving revenue cycle performance.

Responsibilities Required

Verify patient insurance eligibility and benefits to ensure seamless medication access and minimize out-of-pocket costs.
Process prior authorization requests accurately and efficiently, coordinating with healthcare providers to collect required clinical documentation.
Communicate with insurance companies and Pharmacy Benefit Managers (PBMs) to facilitate approvals and resolve coverage issues.
Resolve billing discrepancies and insurance denials by conducting root cause investigations and following up with payers for timely resolution.
Maintain up-to-date knowledge of PBM policies, insurance guidelines, and regulatory requirements to ensure compliance and optimal service delivery.
Submit and track claims while ensuring proper documentation and adherence to internal billing procedures.
Support patients by explaining insurance coverage details and authorization requirements clearly and professionally.
Collaborate with pharmacists, physicians, and administrative teams to streamline medication approval workflows.
Maintain accurate records of prior authorizations, claim submissions, denials, and resolution outcomes.
Ensure compliance with healthcare data privacy standards and internal hospital policies.
Contribute to continuous improvement initiatives aimed at reducing turnaround time for approvals and minimizing claim rejections.

Qualifications

The ideal candidate should have strong knowledge of pharmacy insurance processes, billing systems, and regulatory frameworks within healthcare environments.

Educational Requirements:

Bachelor’s degree in Pharmacy, Health Administration, or a related healthcare field (preferred).
Relevant certifications such as Certified Pharmacy Technician (CPhT) or Medicare/Medicaid certification are advantageous.

Experience and Skills:

Minimum 2 years of experience in a pharmacy or hospital setting with focus on insurance coordination or billing processes.
Experience working with various insurance systems and understanding pharmacy benefit structures.
Knowledge of prior authorization processes and PBM policies.
Strong analytical skills to investigate billing discrepancies and claim denials.
Excellent communication skills for interacting with patients, providers, and insurance representatives.
Familiarity with healthcare compliance standards and data privacy regulations.
Ability to manage multiple claims and authorization requests efficiently.
Attention to detail and strong documentation practices.

Salary Insights

Compensation will be competitive and aligned with UAE healthcare industry standards for professionals with insurance coordination experience. Salary will depend on experience level, certifications, and operational expertise.

Benefits may include:
Competitive salary package
Professional development opportunities
Exposure to accredited healthcare systems
Structured career growth within hospital operations

Company Overview

Zulekha Hospital LLC is a leading healthcare provider in the UAE, operating two multi-disciplinary hospitals in Sharjah and Dubai, along with multiple medical centers and pharmacies. The organization is JCI accredited and a recipient of the Dubai Quality Award, reflecting its commitment to excellence in healthcare delivery.

With advanced super specialty units including Cardiac Care, ICU, and NICU, and comprehensive diagnostic facilities, Zulekha Hospitals is dedicated to delivering patient-centered care supported by strong administrative and compliance systems.

FAQs

1. Is prior authorization experience mandatory?
   Yes, candidates must have hands-on experience in insurance verification and prior authorization processes.

2. Are pharmacy qualifications required?
   A Bachelor’s degree in Pharmacy or Health Administration is preferred, though related healthcare experience is also considered.

3. What systems should candidates be familiar with?
   Insurance billing systems, PBM processes, and healthcare claim management platforms.

4. Is certification required?
   Certifications like CPhT or Medicare/Medicaid credentials are advantageous but not mandatory.

5. What is the primary focus of the role?
   Ensuring seamless medication access by managing insurance verification, prior authorization approvals, and billing compliance.

Application Tips

Highlight your experience with insurance systems and prior authorization handling.
Mention PBM knowledge and any certifications obtained.
Provide examples of claim denial resolutions or billing discrepancy investigations handled.
Demonstrate strong communication skills and patient interaction experience.
Be prepared to discuss real-life scenarios related to insurance coordination and compliance management.