Joint Senior Manager Surveillance-(PHR/1001/4)

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

• Liaise with Claims Manager and Medical Team for effective monitoring and surveillance activities.
• Review and verify hospital rate lists and recommend revisions for all panel hospitals.
• Verify reimbursement claims through on-ground validation to establish claim credibility prior to payment.
• Monitor surveillance team visits to panel hospitals and ensure required admission documents (CNIC, AICL card, credit letter, etc.) are in place as per SLAs.
• Identify and control unnecessary or prolonged hospital stays to avoid unjustified expenditures.
• Review Case Management Reports (CMRs) regularly to ensure smooth workflow and compliance.
• Monitor Pre-Authorization (PA) data for pre-authorization and enhancement cases.
• Manage and develop surveillance teams nationwide, including workload monitoring, performance evaluation, feedback, and identification of training and development needs.
• Perform any other duties assigned by management within agreed timelines.

Requirements

• Education: MBBS
• Experience: 8–10 years of relevant experience
• Industry: Insurance / Hospital Administration
• Age Range: 35–40 years
• Skills & Traits:
• Strong team management and leadership skills
• Effective communication and coordination
• Extroverted personality with stakeholder-handling ability

Job Type: Full-time

Pay: Rs200,000.00 - Rs250,000.00 per month

Work Location: In person