Remote Pharmacy Insurance Support Specialist (Pharmacist, Pakistan)

Responsibilities

• Verify eligibility and benefits for both pharmacy and medical benefits, including coverage details and patient responsibility
• Support prior authorization (PA) intake by gathering required information and submitting documentation to the appropriate channels
• Check PA status updates and follow up on pending requests with payers, PBMs, and plan portals
• Work claim rejects by identifying common rejection reasons and documenting clear next steps
• Troubleshoot rejection scenarios (coverage, PA required, refill too soon, quantity limits, NDC issues, coordination of benefits) and route items appropriately
• Call payers and PBMs and communicate professionally to obtain coverage, approval status, and claim guidance
• Use payer and PBM portals to retrieve claim outcomes, coverage rules, and required forms
• Support copay cards and patient assistance programs from an administrative perspective (enrollment steps, documentation collection, status tracking)
• Maintain accurate documentation in a tracker, spreadsheet, CRM, or pharmacy workflow system as assigned
• Coordinate updates and handoffs with US-based licensed pharmacists, technicians, and the pharmacy operations team
• Prepare clean summaries of payer conversations, reference numbers, and required follow-up actions
• Escalate complex, time-sensitive, or unclear cases to the US-based team with organized notes and supporting documents
• Protect sensitive patient information and follow internal policies for access, storage, and communication

Required qualifications

• Pharmacy degree (PharmD, BPharm, or equivalent) from a recognized institution
• Strong US medical terminology and comfort reading clinical and insurance-related documentation
• Excellent spoken and written English with professional phone etiquette
• Experience supporting US insurance workflows, or strong aptitude demonstrated through relevant examples (claims, benefits verification, PA coordination)
• Comfort speaking with payers and PBMs, asking structured questions, and resolving administrative issues
• Strong attention to detail and ability to document accurately, consistently, and clearly
• Ability to manage multiple cases, prioritize effectively, and follow up until resolution or escalation
• Reliable internet connection, quiet workspace, and a headset suitable for calls
• Pakistan-based, remote worker able to overlap with US business hours

Nice to have

• Experience with specialty pharmacy processes and high-touch insurance coordination
• Medicare Part D familiarity (coverage stages, rejections, and common plan requirements)
• Understanding of PBM concepts such as BIN/PCN/Group ID, formulary, and payer routing
• Familiarity with prior authorization platforms and payer portal workflows
• Experience using pharmacy management systems, ticketing tools, or CRMs
• Strong spreadsheet skills (filters, structured tracking, basic formulas)
• Experience with claims follow-up, reversals, coordination of benefits, or secondary coverage troubleshooting
• Familiarity with copay assistance program workflows for specialty medications

Job Type: Full-time

Pay: Rs100,000.00 - Rs125,000.00 per month

Work Location: Remote