OBJECTIVES OF THE PROGRAMME
The Department of Finance's (FNM) objectives are to support Country Offices, Regional Offices and Headquarters in all financial matters to ensure precise and timely services to colleagues throughout the Organization, including hosted entities. Financial services include Treasury, investments, Staff Health Insurance (SHI), pension and other insurances. To set financial policy, issue annual financial statements and manage WHO external audit; to maintain transparency, accountability and trust in WHO by all stakeholders. To provide the best customer service possible, facilitating access to benefit entitlements for the WHO family worldwide and efficient processing of all related benefits using innovative technology. The objective of the WHO SHI is to provide for the reimbursement of a major portion of the expenses for medically recognized healthcare incurred by staff members, and other persons admitted as participants to the SHI. SHI, located within FNM, is a separate financial entity, with its own budget and Governance structure.
DESCRIPTION OF DUTIES
- Assesses the SHI quality assurance systems and contributes to their overall development, implementation, and execution of cost containment strategies.
- Develops, writes, and implements new quality assurance procedures and Standard Operating Procedures (SOPs).
- Establishes an annual compliance verification workplan to monitor the operational effectiveness of the SHI quality assurance systems, and to identify and report any material issues and irregularities in the SHI claims processing environment.
- Conducts regular monitoring by collection of data through the SHI claims system and Power BI, analyses trends, and prepares reports as required to identify opportunities to improve patient care, improve benefits, reduce costs and contributes to the revision of SHI Rules when appropriate.
- Negotiates with HCPs globally and contributes to due diligence assessments to support the establishment of increased HCPs that provide value for money services with verified prices, overseeing and monitoring of charges, and where excessive charges are identified for further adjudication supports the Claims Management Officer's negotiations with HCP to reduce the cost and advises in the reviewing, researching, investigation of such claims when appropriate.
- Provides advice on the overall benefits of the plan, benchmarking with other organizations and identifying opportunities to revise SHI benefits to optimize the quality and cost of care provided to participants.
- Monitors the implementation and follows up on open internal and external audit recommendations with relevant SHI colleagues.ย
- In consultation with and under direct supervision of Head SHI maintains the SHI risk register, as appropriate.ย
- Responsible for updating the SHI Business Continuity Plan (BCP), Supervises the P.2 Compliance and Risk Management Officer and the G.5 Compliance Assistant in the execution of their assigned tasks.
- Performs other related duties as required.
REQUIRED QUALIFICATIONS
Education
Essential:
- University degree (Bachelor's degree or equivalent) in health administration, insurance, audit, compliance or related field.
Desirable:
- Advanced level university degree in health administration, insurance, audit, compliance or related field.
Experience
Essential:
At least five years of experience in relevant health insurance or health care administration functions.Desirable:
At least 1-3 years medical or related insurance claims adjudication experience Experience in an international health insurance environment. Experience working with outsourced service providers.
Skills
Essential Knowledge and skills
Knowledge of quality assurance, internal control and audit principles and their application in the context of health insurance. Excellent knowledge of the health insurance sector. Excellent knowledge of compliance processes and financial audits. Quality focused with excellent analytical - and creative problem-solving skills, sound judgment and attention to detail. Excellent interpersonal skills. Ability to work with minimal guidance/supervision and prioritize own workload in a high pressure and time-constrained environment. Positive attitude to learning new skills and adapt to new technologies. Ability to work well as part of a team in a multicultural environment. Ability to communicate clearly and concisely, in oral and writing.Desirable Knowledge and Skills
Knowledge of health insurance policies, processes and systems. Knowledge of the staff health insurance programmes of the UN agencies. Applied knowledge of the healthcare digital platforms, and ERP systems (Oracle or Workday preferred). Applied knowledge of MS SharePoint, Power BI applications and tools.
WHO Competencies
Teamwork Respecting and promoting individual and cultural differences Communication Producing results Moving forward in a changing environment Creating an empowering and motivating environmentUse of Language Skills
Essential:
Expert knowledge of English. Expert knowledge of French.Desirable:
Intermediate knowledge of any other official WHO languages.REMUNERATION
WHO salaries for staff in the Professional category are calculated in US dollars. The remuneration for the above position comprises an annual base salary starting at USD 64,121 (subject to mandatory deductions for pension contributions and health insurance, as applicable), a variable post adjustment, which reflects the cost of living in a particular duty station, and currently amounts to USD 4879 per month for the duty station indicated above. Other benefits include 30 days of annual leave, allowances for dependent family members, home leave, and an education grant for dependent children.