Pharmaceutical Policy and Reimbursement Specialist

2 days ago

Melbourne, Victoria, Australia beBeePharmaceutical Full time $120,000 - $180,000

**Job Overview**

We are seeking a highly skilled Pharmaceutical Policy and Reimbursement Specialist to join our team. In this role, you will play a critical part in ensuring the safe, effective, and cost-efficient delivery of pharmaceutical benefits within our health insurance programs.

Key Responsibilities:

  • Manage and maintain our drug database and related collateral to ensure medications listed for reimbursement align with pharmacy and product policies.
  • Provide expert pharmaceutical advice to product teams to ensure compliance with private health insurance legislation and regulations.
  • Ensure we adhere to PBS, TGA, and other regulatory standards relating to drug coverage and reimbursement.
  • Analyse pharmaceutical data to identify trends, risks, or potential claims leakage.
  • Advise our hospital contracting team on high-cost drug clauses during contract negotiations, offering insights into pricing, reimbursement models, and regulatory requirements.

About You

To be successful in this role, you will need to have a strong foundation in pharmacy practice and a strategic mindset that extends beyond day-to-day operations. Key qualifications include:

  • A Registered Pharmacist with a Bachelor of Pharmacy (or equivalent).
  • 5+ years' experience across clinical, hospital, community, or industry settings.
  • Strong knowledge of high-cost medicines, funding frameworks, and relevant regulations (PBS, TGA, private health insurance).
  • Strategic thinker with the ability to challenge the status quo and shape forward-looking initiatives.
  • Skilled communicator with proven influence across senior leaders, clinicians, and operational teams.

About Our Team

Our team is a passionate and professional group of individuals who care deeply about the work we do. We operate in a unique corporate and clinical environment with extremely high standards, compliance, and contractual obligations. We are known for being driven and responsive to the needs of our health insurance members, putting our customers at the centre of everything we do.

If you're a motivated and experienced Pharmaceutical Policy and Reimbursement Specialist looking for a new challenge, we'd love to hear from you.

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