Website perks HR
JOB DESCRIPTION:
Purpose of the Role
The Joint Senior Manager – Surveillance is responsible for maintaining a win-win relationship between clients and the company by ensuring provision of quality healthcare services while preventing unnecessary hospitalization expenses, prolonged stays, and fraudulent or non-credible reimbursement claims. The role ensures effective surveillance operations in compliance with SLAs and SOPs.
Key Responsibilities
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Liaise with Claims Manager and Medical Team for effective monitoring and surveillance activities.
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Review and verify hospital rate lists and recommend revisions for all panel hospitals.
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Verify reimbursement claims through on-ground validation to establish claim credibility prior to payment.
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Monitor surveillance team visits to panel hospitals and ensure required admission documents (CNIC, AICL card, credit letter, etc.) are in place as per SLAs.
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Identify and control unnecessary or prolonged hospital stays to avoid unjustified expenditures.
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Review Case Management Reports (CMRs) regularly to ensure smooth workflow and compliance.
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Monitor Pre-Authorization (PA) data for pre-authorization and enhancement cases.
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Manage and develop surveillance teams nationwide, including workload monitoring, performance evaluation, feedback, and identification of training and development needs.
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Perform any other duties assigned by management within agreed timelines.
Requirements
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Education: MBBS
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Experience: 8–10 years of relevant experience
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Industry: Insurance / Hospital Administration
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Age Range: 35–40 years
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Skills & Traits:
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Strong team management and leadership skills
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Effective communication and coordination
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Extroverted personality with stakeholder-handling ability
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