SHI Quality Assurance, Benefits and Risk Management Officer

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.
• In consultation with and under direct supervision of Head SHI maintains the SHI risk register, as appropriate.
• 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.
• A relevant technical diploma or certification in health insurance, insurance, risk management or compliance.

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 environment
  
  

Use 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.

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.
• Staff members in other duty stations are encouraged to apply.
• 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.
• Mobility is a condition of international professional employment with WHO and an underlying premise of the international civil service. Candidates appointed to an international post with WHO are subject to mobility and may be assigned to any activity or duty station of the Organization throughout the world.
• 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.
• 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.
• For WHO General Service staff who do not meet the minimum educational qualifications, please see e-Manual III.4.1, para 220.
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