General Service (GS) Roster for Temporary and Fixed-Term, G5 Staff Health Insurance Assistant

Contract

This is a G-5 contract. This kind of contract is known as General Service and related categories. It is normally only for nationals. It usually requires 5 years of experience, depending on education. More about G-5 contracts.

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:

2. 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.

3. Refer claims exceeding thresholds to the Medical Adviser in HQ for approval (e.g. physiotherapy, speech therapy and psychotherapy) via appropriate supporting documentation.
4. Contact and/or prepare correspondence to health care providers and participants when necessary to ascertain the veracity of bills or discuss other issues related to SHI matters/claims.
5. Prepare SHI letters of guarantee for hospitalization, attestations, and draft own correspondence.
6. Review HCP bills and process them for direct payment ensuring complete supporting documents and accuracy of HCP banking details.

7. 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.

8. Health Care Provider (HCP) Network:

9. 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.

10. Maintain central list of HCPs and ensure contracts and price lists are updated on a regular basis.

11. Compliance Risk and Fraud Prevention and Detection:

12. Propose standard price lists for main medical interventions in assigned service area to set a benchmark against which claims can be reviewed for compliance.

13. Discuss high costs with participants to alert them to potential abuse from HCPs.

14. Raise any suspicious or suspected cases of fraud to the SHI Compliance Officer and BFO to advise on next steps.

15. Case Management and Cost Containment:

16. Constantly check claims for possible ways to reduce costs and discuss with HCPs directly when claims seem excessive per SHI Rule C.1.

17. 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 education.

Desirable: University degree/diploma in pharmacy, health sciences, business administration or accounting.

Experience

Essential: At least five years of progressively responsible experience in insurance, administration, or accounting.

Desirable: Experience working with a diverse clientele that includes national and expatriate staff.

Functional Knowledge and Skills

• Knowledge of pharmaceutical products and medical terminology and laws and practices of medical insurers.
• Ability to understand and apply administrative rules and regulations relating to health insurance.
• Solid organizational skills and demonstrated ability to prioritize tasks.
• 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

WHO global Competencies model at http://www.who.int/employment/WHO_competencies_EN.pdf?ua=1

1. Teamwork

2. Respecting and promoting individual and cultural differences

3. Communication

4. Moving forward in a changing environment

5. Producing results

Use of Language Skills

Essential: Excellent knowledge of English and Arabic. Desirable: Knowledge of French is an asset.

Other Considerations (e.g. Physical Workplace Condition, if other than normal office environment; IT Skills; etc.)

• Proficiency in the use of Microsoft Office and standard office equipment.
• Sound skills in utilizing enterprise resource planning systems, databases, and other systems for health insurance claims processing.
• Working knowledge of GSM and SHI HIIS is an advantage.

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 EGP 235,531 (subject to mandatory deductions for pension contributions and health insurance, as applicable) and 30 days of annual leave.

ADDITIONAL INFORMATION

• This vacancy is used to replenish the roster of the G5 Staff Health Insurance Assistant position in the Regional Office, it is to be used for filling temporary and fixed term positions.

• 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 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.

• Duration of contract will depend on the needs of the department / unit.
• Interested candidates are strongly encouraged to apply on-line through Stellis. For assessment of your application, please ensure that: (I) Your profile on Stellis is properly completed and updated; (ii) All required details regarding your qualifications, education and training are provided; (iii) Your experience records are entered with elaboration on tasks performed at the time. Kindly note that CVs/PHFs inserted via LinkedIn are not accessible.