Compliance and Risk Management Officer

Overview

Oversee compliance and risk management for health insurance operations.

You have:

• University degree in healthcare administration, insurance, business, law, public administration or a directly related area.
• Minimum of five years of experience in relevant healthcare administration functions, or related compliance, audit, law or quality control environment.
• Excellent knowledge in the area of health insurance sector.
• Knowledge of internal control and audit principles in the context of SHI.
• Excellent knowledge of compliance processes and financial audits.
• Strong analytical skills and attention to detail in a high-pressure environment.
• Ability to communicate clearly in oral and writing.
• Expert knowledge of English and French.
• Knowledge of WHO Financial Regulations and Financial Rules.
• Desirable: Intermediate knowledge of another WHO language.

Contract

This is a P-3 contract. This kind of contract is known as Professional and Director staff. It is normally internationally recruited only. It's a staff contract. It usually requires 5 years of experience, depending on education.

Salary

The salary for this job should be between 139,444 USD and 182,591 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.

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 usinginnovative 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 tothe SHI. SHI is a separate financial entity, with its own budget and Governance structure. SHI is located within FNM.

DESCRIPTION OF DUTIES

- Assesses the SHI quality assurance systems and contributes to their overall development, implementation, and execution of cost containment strategies.

- Establishes 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.

- Develops, writes, and implements new quality assurance procedures and SOPs.

- 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.

- Provides expertise to the claims processing teams in reviewing, researching, investigating, negotiating, processing and adjusting claims.

- Oversees the monitoring of charges, and where excessive charges are identified supports SHI management's negotiations with HCPs to reduce SHI claims costs and costs to participants.

- Implements global verification mechanisms for SHI claims, prior to clearance for payment.

- Identifies, addresses and provides support on compliance and risk issues in collaboration with SHI teams.

- In consultation with and under direct supervision of Head SHI maintains the SHI risk register, as appropriate.

- Supports the Organization's efforts to implement proactive measures to prevent, prepare and respond to fraud in SHI processes and operations.

- In consultation with Head SHI, where an irregular case or case of suspected fraud is identified, conducts the initial assessment and prepares case file for referral to the Office of Internal Oversight Services (IOS) teams in HQ or in AMRO/PAHO.

- Implements audit recommendations and follows up on open internal and external audit reports in relation to compliance of SHI claims.

- Conducts regular monitoring by collection of data through the SHI claims system and Power BI, analyzes trends, and prepares reports as required to identify opportunities to improve patient care.

- Engages with relevant internal stakeholders, including within SHI, to track and follow up on action and progress in relevant areas in connection with the assigned duties.

- Monitors critical SHI tasks (spot checks, requests under relevant SHI Rules, integration of rule changes into SHI's IT system, health care provider data clean-up, claims validation) and proposes appropriate measures to ensure business continuity, confidentiality, and data protection.

- Responsible for updating the SHI Business Continuity Plan (BCP).

- Provides back-up in other SHI areas in case of emergency - BCP, Subject Matter Expert (SME).

- Provides guidance on SHI Rules and contributes to their revision.

- Supervises the P2 Compliance and Risk Management position and the G5 Compliance Assistant in the execution of their assigned tasks.

- Performs other related duties as required.

REQUIRED QUALIFICATIONS

Education

Essential: University degree in healthcare administration, insurance, business, law, public administration or in a directly related area relevant to the functions of the position. Desirable: Advanced university degree, or specific qualifications relevant to an insurance or quality assessor/risk management assessor i.e. Chartered Insurance Professional, Diploma of Loss Adjusting or Chartered Loss Adjustor or Claims Assessor or Risk Management and Quality Assurance or a Compliance Assessor.

Experience

Essential: Minimum of five years of experience in relevant healthcare administration functions, or related compliance, audit, law or quality control environment. Desirable: 1-3 years medical or related insurance claims adjudication experience. Experience in an international health insurance environment. Experience in working in a multicultural team and working with outsourced service providers.

Skills

- Knowledge of internal control and audit principles and their application in the context of SHI.

- Excellent knowledge in the area of health insurance sector.

- 1-3 years medical or related insurance claims adjudication experience.

- Excellent knowledge of compliance processes and financial audits.

- Quality focused with excellent analytical skills, attention to detail and capable of prioritizing own workload in a high pressure and time constrained environment.

- Excellent interpersonal and communication skills.

- Ability to work with minimal guidance/supervision and prioritize own workload in a 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.

- Analysis and troubleshooting skills, with aptitude/sound judgment for creative problem solving.

- Ability to communicate clearly and concisely, in oral and writing.

- Desirable Knowledge and Skills Knowledge of health insurance processes and systems.

- Knowledge of WHO Financial Regulations and Financial Rules, SHI Rules, WHO procedures and practices and advantage.

- Applied knowledge of Power BI applications and tools.

- Applied knowledge of the ERP systems (Oracle or Workday preferred).

- Applied knowledge of MS Sharepoint.

- Knowledge of the staff health insurance programmes of the various UN agencies is an advantage.

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 another WHO language.

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 62,692 (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 3709 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 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.

• Staff members in other duty stations are encouraged to apply.

• 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.

• WHO has a mobility policy which can be found at the following link: http://www.who.int/employment/en/. 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.

• Applications from women and from nationals of non and underrepresented Member States are particularly encouraged.

• *For WHO General Service staff who do not meet the minimum educational qualifications, please see e-Manual III.4.1, para 220.

Potential interview questions