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Job Description

  • To maintain a win - win relationship between Clients and Company ensuring the provision of health care facilities and simultaneously preventing; unnecessary hospitalization expenditures, prolonged stay, check credibility of suspected reimbursement claim ensuring monitoring unit performs as per the SLAs and SOPs.
  • Liaise with manager claims and medical team for monitoring purpose.
  • Check the rate lists for revision of rates for all panel hospital
  • Check the reimbursement claims through verification on ground and to establish the credibility of claim before its payment to clients.
  • Monitor the team visiting the panel hospital and to check the documents necessary for admission in hospital (copy of CNIC, copy AICL card/credit letter etc) ensuring admission is done as per the agreed SLAs.
  • Check the unnecessary and prolonged hospital stay to avoid unjustified expenditures.
  • Check the CMR reports of Case Managers regularly for smooth process flow.
  • Check the PA data for pre authorization and enhancement case accordingly.
  • Manage and develop team: monitor workload, ensure job proficiency, develop career goals by evaluating and monitoring individual staff performance and giving appropriate feedback and identify training and development needs.



Job Details

Functional Area:
Total Positions:
1 Post
Job Shift:
First Shift (Day)
Job Type:
Job Location:
No Preference
Minimum Education:
Degree Title:
Career Level:
Experienced Professional
6 Years - 8 Years (Experience in all surveillance of Health Claims)
Apply Before:
Dec 17, 2017
Posting Date:
Nov 17, 2017
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Adamjee Insurance Company Limited

Insurance / Takaful · 601-1000 employees - Lahore

Adamjee Insurance Company Limited (AICL) was incorporated as a Public Limited Company on September 28, 1960 and is listed on all three stock exchange of Pakistan. The Company is also registered with the Central Depository Company of Pakistan Limited (CDC) and is involved in the business of genera ...Read More