Assistant (Insurance)

This opening expired 1 month ago.

WHO - World Health Organization

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Application deadline 1 month ago: Wednesday 21 Dec 2022 at 22:59 UTC

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Contract

This is a G-6 contract. This kind of contract is known as General Service and related categories. It is normally only for nationals. It usually requires 6 years of experience, depending on education.

Salary

The salary for this job should be more than 7,681 USD.

Salary for a G-6 contract in Geneva

The salary of a G-6 depends on the duty station. The minimum salary there is 7,080 CHF (~7,681 USD)

Please keep in mind that the salary displayed here is an estimation by UN Talent based on the location and the type of contract. It may vary depending on the organization. The recruiter should be able to inform you about the exact salary range. In case the job description contains another salary information, please refer to this one.

More about G-6 contracts.

OBJECTIVES OF THE PROGRAMME

The Department of Finance's 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, 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 health care incurred by staff members, and other persons admitted as participants to the SHI. SHI is a separate financial entity, with its own budget and Governance structure. SHI is located within FNM.

DESCRIPTION OF DUTIES

Under the general supervision of the Claims Management Officer, SHI, the incumbent is assigned to the receipt and processing of health insurance claims for direct payments to health care providers.

Medical Claims for Direct Payment (75%):

1. Examines medical claims submitted by participants to the SHI or directly from health care providers in accordance with the rules of the Staff Health Insurance and the interpretation made by the SHI/GSC, in particular: verifies bank accounts and postal addresses of the health care provider; ensures that bills are submitted within established time limits; verifies accuracy of the amounts claimed; for each prescription of drugs, ensures that the medicaments prescribed are reimbursable in terms of the rules and established guidelines; verifies the presence of a physician's prescription in respect of special forms of treatment; in the case of hospitalization, checks whether the daily rates charged are within established limits and adjusts the claim as appropriate; ensures that sufficient information is provided to permit a meaningful analysis of the claims. If in doubt as to whether the claim qualifies for reimbursement, requests a medical report to be sent to the Medical Adviser; verifies entitlement to coverage.

2. Prepares input documents for the processing of claims by computer.

3. Enters and validates daily claims on computer.

4. Contacts and/or prepares correspondence to healthcare providers, i.e. physicians, dentists, clinics, laboratories, etc.concerning medical claims/payment requests.

5. Meets participants of the SHI to provide information on claims and procedures for direct payments and hospitlizations and provides similar information by telephone and email.

6. Validates claims pre-coded by regions and processes payment.

7. Prepares letters of guarantee for hospitalizations.8.Enters names and bank details of health care providers directly into the SHI HIIS.

Cost Containment and Case Management (15%):

1. Must keep up to date with current prices in major countries of health care and negotiate with health care providers when costs seem to be excessive. Escalates to Medical Adviser and supervisor when case is over USD200,000 or complex. Maintains data on cost savings per case.

2. Keeps up to date SHI list of standard costs, problem health care providers on SharePoint.

C. Fraud Prevention and Detection (10%):

In line with SHI SOP on fraud and in close contact with the SHI Compliance Officer and supervisor, part of daily work is to prevent and identify suspected fraud cases and prepare initial data for the case to be escalated.

REQUIRED QUALIFICATIONS

Education

Essential: Completion of secondary school education or equivalent. Desirable: Higher education an advantage.

Experience

Essential: A minimum of 8 years' experience in health insurance, which should include 2 years' experience in administration and finance. Desirable: Experience in UN health insurance involving a multi-country network.

Skills

The incumbent controls an ever-increasing workload by revising priorities often on a daily basis and often several times a day. The incumbent uses mature judgement when responding to unusual requests, courtesy when redirecting callers and diplomacy when dealing with sensitive claims and drawing attention to staff on specific insurance rules. Incumbent ensures cases of potential fraud are escalated to management after initial investigation and escalates excessive billing over USD200,000 to management and deals directly with all other cases. Incumbent must be able to work independently and, in a team, and work in the up most of confidentiality. In-depth knowledge of: WHO SHI rules, staff rules, financial regulations of WHO, Swiss and French Medical Procedure/supply codes.

WHO Competencies

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

Use of Language Skills

Essential: Intermediate knowledge of English. Expert knowledge of French. Desirable:

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 CHF 82,568 (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 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.

  • Any appointment/extension of appointment is subject to WHO Staff Regulations, Staff Rules and Manual.

  • For information on WHO's operations please visit: http://www.who.int.

  • WHO is committed to workforce diversity.

  • 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.

  • This post is subject to local recruitment and will be filled by persons recruited in the local commuting area of the duty station.

Added 2 months ago - Updated 1 month ago - Source: who.int