Posted Nov 17, 2017 65 views
- 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
Adamjee Insurance Company Limited
pAdamjee 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 general insurance. The head office is located in Karachi and it operates a network of branches all across Pakistan and two in UAE (Dubai & Abu Dhabi). The Company commenced operations with a paid-up capital of Rupees 2.5 million, which has grown phenomenally in the past five decades to Rupees 1.24 billion, as on 31 December 2012. A strong asset base, significant paid-up capital, substantial reserves, balanced portfolio mix along with steady growth in gross premium account gives Adamjee Insurance a well deserved competitive edge within the insurance industry./p
What is your Competitive Advantage?
Zubair Anjum
Business Excellence Specialist
Nestle Pakistan
Usman Habib
Recruitment & Training Executive
ACS Synergy (Pvt) Ltd.
Sehrish Azhar
Motivational Speaker & Blogger
Living Upbeat
Ali Aziz
CEO
Shopistan
Ayesha Shaukat
Social Media Marketing Manager
Ivoke
Muzammil Baig
Digital Marketing Manager
IT Services Group
Babar Ahmed Khan
Territory Sales Manager
Engro Foods
Aqib Irshad
Head of HR, Training & OD
FINCA
Zohaib Ali
Marketing Manager
Digital Online Devices
Mona Sharif
Senior Team Lead
Konext PVT. LTD
