Are you ready to take on the role of Prescription Control Officer? In this role, you will review and validate prescription claims and reimbursements for accuracy, completeness, and eligibility; while monitoring insured and provider practices to detect discrepancies, support compliance, mitigate abuse, and prevent fraud all while ensuring cost control.

Key Duties & Responsibilities:

• - Register and verify submitted hardcopy pharmacy claims and prescriptions for legitimacy and accuracy, stamp processed prescriptions, and ensure proper documentation.
• - Enter hardcopy pharmacy claims from foreign providers into the claims system, review prescriptions for specialist legitimacy and permitted medications, and validate compliance.
• - Import electronic claim files, validate formats, and reject incorrect submissions with feedback to pharmacies.
• - Verify the completeness of claims, the originality of prescriptions, and compliance with medication quantity and limit requirements.
• - Register eyeglasses prescriptions, confirm insured eligibility, calculate reimbursements, and forward approvals to providers or Claims Officers as required.
• - Process prescription lines, review system error lists, resolve discrepancies, and override system rules in line with SZV procedures if necessary.
• - Upload Z-index files with Dutch rates, input local supplier pricing if necessary, and maintain the claims system synonym database to ensure claims processing aligns with accurate code and pricing data.
• - Regularly update provider records (general practitioners, specialists, pharmacists) to ensure accurate and reliable data for claims processing.
• - Review and validate prescriptions submitted in medical reimbursement requests, ensuring eligibility, legitimacy, and completeness.
• - Assess and calculate eligible reimbursement amounts, providing guidance on the review and approval processes for unique or exceptional reimbursement cases.

Knowledge & Skills

• - Strong understanding of pharmacy and medical claims regulations, pharmaceutical administration, and data analysis.
• - Knowledge of medications, healthcare contracts, and claims/prescription policies.
• - Familiarity with SZV’s automated systems and AO/IC (administrative organization/internal control) processes.
• - Understanding relevant legislation, including national ordinances on:

o Sickness Insurance (AB 2013, GT no. 802).

o Pharmaceutical Provision (AB 2013, GT no. 749).

o Compensation of Medical Expenses for Retired Civil Servants (AB 2013, GT no. 644).

o Medical Treatment and Nursing Reimbursement for Government Employees (AB 2013, GT no. 649).

• - Advanced verbal and written communication skills in Dutch and English.
• - High attention to detail with strong analytical and organizational abilities.

Education & Experience:

• - Associate’s degree/MBO diploma as a Pharmacy Assistant (required).
• - Higher education HBO/Bachelor is a plus but does not replace the Pharmacy Assistant qualification.
• - Minimum of two (2) years’ experience as a Pharmacy Assistant or in a comparable pharmaceutical/healthcare role.
• - Demonstrated ability to work and think at Associate/MBO level within a structured claims environment.

Step into a vital role as Prescription Control Officer, where you will work independently, ensure accuracy and compliance, making a real impact on SZV’s healthcare services. Enhance your expertise in a supportive team environment.

Interested?

Submit your written application with your CV and diplomas/certificates to the People & Culture Department with the subject: Application Prescription Control Officer by October 17, 2025.