About the team

Doctor Anywhere's Operations team plays a vital role in driving the success of our TPA business. Our scope includes end-to-end claims processing, Letter of Guarantee (LOG) issuance, customer service, business processing, and panel network management. We support both virtual and in-person clinical services, ensuring smooth daily operations and swift resolution of any issues. Our focus is on delivering operational excellence and consistently providing a best-in-class customer experience keeping our customers at the heart of everything we do.

About the role

We are seeking a Pharmacist will support the TPA’s medical and claims review function by assessing prescriptions, verifying drug-related information, evaluating claim authenticity, and ensuring compliance with medical and policy guidelines. The role ensures accurate and fair processing of pharmacy-related claims while maintaining high standards of customer service and regulatory compliance.

This role is based in Petaling Jaya, Malaysia and reports directly to the Team Lead, Provider Management

A summary of the key responsibilities are as follows:

Claims Review & Verification

• Review and authenticate prescriptions, treatment plans, and pharmacy bills submitted for claims.
• Evaluate drug dosage, brand/generic details, quantity, and pricing to prevent fraud or misuse.
• Ensure claims comply with policy terms, clinical guidelines, and regulatory norms.
• Coordinate with Provider Management team for clarification of drug-related queries.

Medical & Technical Assessment

• Provide expert pharmaceutical opinion for claim adjudication and approvals.
• Verify drug interactions, contraindications, and therapeutic relevance.
• Maintain updated knowledge of formulary lists, essential medicines, and pricing structures.

Customer & Stakeholder Coordination

• Respond to queries from insured members, hospitals, and internal teams regarding medications and policy coverage.
• Support the Provider Management team in evaluating pharmacy empanelment requests.

Documentation & Reporting

• Maintain accurate claim review records in the TPA system.
• Assist in preparing periodic reports on pharmacy claims trends, fraud detection, and medication usage.
• Ensure compliance with internal SOPs, audit requirements, and regulatory guidelines.

About you

• Valid pharmacist registration/license as per local state/country regulations.
• Minimum 1–3 years of experience in hospital pharmacy, retail pharmacy, insurance/TPA claims review (preferred).
• Good knowledge of drug classifications, dosages, therapeutic areas, and pricing.
• Familiarity with health insurance processes, TPA operations, and claim management systems (advantageous).
• Strong attention to detail and analytical ability.
• Good communication and documentation skills.
• Ability to detect discrepancies, fraud, or inappropriate prescriptions.
• Customer-centric approach with ethical decision-making.
• Proficiency in MS Office and claims processing software.
• A start-up attitude - you take full ownership of things that you do and are willing to go out of your comfort zone and take on new challenges and changes within the organization.
• Comfortable with ambiguity and flexible to learn new things - we’re not done growing and heading into uncharted territories is part of the fun!
  

About Doctor Anywhere

Doctor Anywhere (DA) is a regional tech-enabled, omnichannel healthcare provider delivering care to 2.5 million users across 6 countries in Southeast Asia. Founded in 2017 with a mission to make healthcare simple, accessible, and efficient for all, DA leverages technology to enable individuals towards preventive, long-term health via holistic offerings including our telehealth app, physical clinics and pharmacies, mental wellness, specialist consults, and also an online health & wellness marketplace for supplements, healthy snacks, home-based health screening and vaccinations.

DA’s goal is to build a regional digital healthcare ecosystem, advanced by the 3,000 GPs and specialists within our regional network, over 1,000 corporate organisations, and 25 regional insurers we work with. Grounded in our motto “Keep Going, Keep Growing”, our team strives towards excellence, with innovation and collaboration at our core, and values diversity in perspectives brought by every member. Join us in our mission to transform Southeast Asia’s healthcare future!

Not for you? We have other opportunities that may interest you or someone you know. Feel free to visit us at our careers page - https://doctoranywhere.com/job-listing/ for more information.