Staff Health Insurance Assistant

**Grade**: G5

**Contractual Arrangement**: Fixed-term appointment

**Contract Duration (Years, Months, Days)**: Two years

**Job Posting**: Nov 13, 2024, 3:18:57 AM

**Closing Date**: Dec 4, 2024, 4:59:00 PM

**Primary Location**: India-New Delhi

**Organization**: SE/DAF Director - Administration & Finance

**Schedule**: Full-time

**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 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**

**ADDITIONAL INFORMATION**:

- This vacancy notice may be used to fill other similar positions at the same grade level
- A written test and/or an asynchronous video assessment may be used as a form of screening.
- 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 b