Staff Health Insurance Assistant

OBJECTIVES OF THE PROGRAMME

The objective of WHO SHI is to provide for the reimbursement of a major portion of the expenses for medically recognized health care incurred by staff members and other persons admitted as participants to the Insurance, provide policy guidance, and ensure smooth facilitation of hospitalization during emergencies.

DESCRIPTION OF DUTIES

The incumbent performs the following duties within his/her given portfolio of countries and allocation of participants in the regional office:

1.Claims Management:

• Scrutinize SHI claims and receipted invoices, determine eligibility, and enter in the Health Insurance Input System (HIIS) for reimbursement in accordance with prevailing SHI rules, ensuring that all required documents are correct and included with claims to enable reimbursement. Ensure that claims are accurately processed in a timely manner with appropriate codes and currencies, whether received on-line or by paper envelope.
• Refer claims exceeding thresholds to the Medical Adviser in HQ for approval (e.g. physiotherapy, speech therapy and psychotherapy) via appropriate supporting documentation.
• Contact and/or prepare correspondence to healthcare providers and participants when necessary to ascertain the veracity of bills or discuss other issues related to SHI matters/claims.
• Prepare SHI letters of guarantee for hospitalization, attestations, and draft own correspondence.
• Review Health Care Provider (HCP) bills and process them for direct payment ensuring complete supporting documents and accuracy of HCP banking details. Maintain associate logs and data bank related to HCPs namely, address lists, focal points, bank details etc..
• Provide information to SHI participants on all matters related to SHI using standard briefing packages when appropriate, answer queries about reimbursement, and advise on SHI policies and procedures.

2.Health Care Provider (HCP) Network:

• Identify the main providers (hospitals, clinics, pharmacies, or other HCPs) used by participants for dental, optical, medical, pharmaceutical, and therapeutic services, arrange visits with RSP and WR staff to enable agreements with discounted rates for participants.
• Maintain central list of HCPs and ensure contracts and price lists are updated on a regular basis. Manage proper archiving of agreements/communications with HCPs.

3.Compliance Risk and Fraud Prevention and Detection:

• Propose standard price lists for main medical interventions in assigned service area to set a bench mark against which claims can be reviewed for compliance.
• Discuss high costs with participants to alert them to potential abuse from HCPs.
• Raise any suspicious or suspected cases of fraud to the NPO and BFO to advise on next steps.

4.Case Management and Cost Containment:

• Constantly check claims for possible ways to reduce costs and discuss with NPO/BFO directly when claims seem excessive per relevant SHI rules.
• Identify cases early in treatment to ensure case management with the SHI Medical Adviser and SHI/HQ Claims Management Officer.

REQUIRED QUALIFICATIONS

Education

Essential: Completion of Secondary school education
Desirable: University degree/diploma in pharmacy, health sciences, business administration or accounting.

Experience

Essential: At least 5 years of progressively responsible experience in insurance, administration oraccounting.
Desirable: Experience working with a diverse clientele that includes national and expatriate staff

Skills

• Knowledge of pharmaceutical products and medical terminology and laws and practices of medical insurers.
• Ability to understand and apply administrative rules and regulations relating to health insurance. Solid organizational skills and demonstrated ability to prioritize tasks.
• Ability to work under pressure within established turnaround times and meet performance goals for claims processing with a high level of accuracy.
• Strong client service orientation.
• Demonstrated ability to act with diplomacy and discretion when handling confidential matters.

WHO Competencies

• Teamwork
• Respecting and promoting individual and cultural differences
• Communication
• Moving forward in a changing environment
• Producing results

Use of Language Skills

Essential: Excellent knowledge of English

REMUNERATION

WHO offers staff in the General Services category an attractive remuneration package, which for the above position includes an annual net base salary starting at INR 1,078,604 (subject to mandatory deductions for pension contributions and health insurance, as applicable) and 30 days of annual leave.

ADDITIONAL INFORMATION

• This vacancy notice may be used to fill other similar positions at the same grade level
• Only candidates under serious consideration will be contacted.
• A written test and/or an asynchronous video assessment may be used as a form of screening.
• In the event that your candidature is retained for an interview, you will be required to provide, in advance, a scanned copy of the degree(s)/diploma(s)/certificate(s) required for this position. WHO only considers higher educational qualifications obtained from an institution accredited/recognized in the World Higher Education Database (WHED), a list updated by the International Association of Universities (IAU)/United Nations Educational, Scientific and Cultural Organization (UNESCO). The list can be accessed through the link: http://www.whed.net/. Some professional certificates may not appear in the WHED and will require individual review.
• According to article 101, paragraph 3, of the Charter of the United Nations, the paramount consideration in the employment of the staff is the necessity of securing the highest standards of efficiency, competence, and integrity. Due regard will be paid to the importance of recruiting the staff on as wide a geographical basis as possible.
• Any appointment/extension of appointment is subject to WHO Staff Regulations, Staff Rules and Manual.
• The WHO is committed to creating a diverse and inclusive environment of mutual respect. The WHO recruits and employs staff regardless of disability status, sex, gender identity, sexual orientation, language, race, marital status, religious, cultural, ethnic and socio-economic backgrounds, or any other personal characteristics.
• The WHO is committed to achieving gender parity and geographical diversity in its staff. Women, persons with disabilities, and nationals of unrepresented and underrepresented Member States (https://www.who.int/careers/diversity-equity-and-inclusion) are strongly encouraged to apply.
• Persons with disabilities can request reasonable accommodations to enable participation in the recruitment process. Requests for reasonable accommodation should be sent through an email to reasonableaccommodation@who.int
• An impeccable record for integrity and professional ethical standards is essential. WHO prides itself on a workforce that adheres to the highest ethical and professional standards and that is committed to put the WHO Values Charter into practice.
• WHO has zero tolerance towards sexual exploitation and abuse (SEA), sexual harassment and other types of abusive conduct (i.e., discrimination, abuse of authority and harassment). All members of the WHO workforce have a role to play in promoting a safe and respectful workplace and should report to WHO any actual or suspected cases of SEA, sexual harassment and other types of abusive conduct. To ensure that individuals with a substantiated history of SEA, sexual harassment or other types of abusive conduct are not hired by the Organization, WHO will conduct a background verification of final candidates.
• WHO has a smoke-free environment and does not recruit smokers or users of any form of tobacco.
• For information on WHO’s operations please visit: http://www.who.int.
• WHO also offers wide range of benefits to staff, including parental leave and attractive flexible work arrangements to help promote a healthy work-life balance and to allow all staff members to express and develop their talents fully.
• The statutory retirement age for staff appointments is 65 years. For external applicants, only those who are expected to complete the term of appointment will normally be considered.
• Please note that WHO’s contracts are conditional on members of the workforce confirming that they are vaccinated as required by WHO before undertaking a WHO assignment, except where a medical condition does not allow such vaccination, as certified by the WHO Staff Health and Wellbeing Services (SHW). The successful candidate will be asked to provide relevant evidence related to this condition. A copy of the updated vaccination card must be shared with WHO medical service in the medical clearance process. Please note that certain countries require proof of specific vaccinations for entry or exit. For example, official proof /certification of yellow fever vaccination is required to enter many countries. Country-specific vaccine recommendations can be found on the WHO international travel and Staff Health and Wellbeing website. For vaccination-related queries please directly contact SHW directly at shws@who.int.
• This post is subject to local recruitment and will be filled by persons recruited in the local commuting area of the duty station.
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