Avis de recrutement : OMS recherche un(e) Spécialiste des finances, assurance maladie du personnel basé aux Etats-Unis.

 

 

 

 

 

This requisition is for employment at the Pan American Health Organization (PAHO)/Regional Office of the World Health Organization (WHO)

The Department of Financial Resources Management (FRM) oversees the financial transactions of the Organization by establishing the accounting policies and procedures, in accordance with PAHO’s Financial Regulations and Rules; processes the disbursements of funds; prepares the financial statements of the Organization; monitors the inflow of funding and utilization of these resources; is responsible for investments  and  banking,  financial  analysis,  the monitoring of the cost  centers’  financial  administration;   payroll,  pension,  taxes,  Staff Health Insurance, and the processes and systems involved with FRM’s area of responsibility.

DESCRIPTION OF DUTIES

Under the general supervision of the Director, FRM, and the direct supervision of the Advisor, Staff Benefits, (FRM/SB), the incumbent is responsible for, but not necessarily limited to, the following assigned duties:

  1. Plan and supervise the day-to-day operations of Staff Health Insurance including the application of the rules, regulations, policies and procedures applicable to the SHI program and the reimbursement of medical claims; monitor operations with Cigna and Navitus;
  2. Implement and maintain adequate controls for the orderly and proper processing of claims and the clearance and/or collection of accounts resulting from the process of direct payments to medical providers;
  3. Collaborate and lead the examination and evaluation of alternative insurance plans and plan administrators, leading periodic tendering of contracts, participating in the tendering process, as a team leader, and making recommendations, as required, to senior administrative officers;
  4. Prepare, coordinate, and conduct workshops for active and retired staff members on insurance benefits and requirements, case management alternatives, and cost savings opportunities;
  5. Review selected medical charges for conformance with usual and customary medical costs for similar services and initiate inquiries where required;
  6. Provide direction and guidance to third-party administrators contracted to administer benefits in accordance with on the Staff Health Insurance Rules and Regulations, payment and reimbursement policies and procedures, specific claims eligibility, and other matters relating to SHI claims administration;
  7. Develop and implement medical cost containment and cost reduction programs utilizing creative approaches and techniques as well as experience and methods available through external sources;
  8. Maintain close liaison with the Insurance Offices of other International Organizations in Washington, D.C. and New York City, New York with respect to their insurance programs (for benchmarking), medical cost experience and cost containment initiatives;
  9. Coordinate with other FRM Offices and Areas within Administration (i.e. HRM and ITS) regarding active staff eligibility, and establishing eligibility and coverage for retirees and survivors, ensuring collection of contributions from all participants;
  10. Review requests for guarantees of coverage, facilitating medical hospital admissions and access to emergency care, authorizing medical advances or issuing payment in the United States and in country offices in exceptional circumstances, and monitoring the status of these cases and the corresponding  advance accounts;
  11. Identify claims irregularities, initiate special reviews and provide findings and recommendations to the Administration and in accordance with relevant policies and procedures;
  12. Monitor the status of SHI Accounts Receivables including the initiation of follow-up correspondence and collection action;
  13. Prepare monthly  financial activity reports with respect to the Health Insurance Program in the Region of the Americas and review as required with the Director, Financial Management and Reporting (FRM);
  14. Prepare required documentation on medical cases to be submitted to the Global Standing Committee and/or the SHI Medical Advisor, as required, in conformance with the SHI Rules.  Maintain appropriate files with respect to Committee discussions and decisions and inform claimants of such decisions;
  15. Administer the billing and collection process for retiree health insurance contributions in coordination with the Insurance Office in WHO Headquarters.  Coordinate accounting and transfer actions with the Chief, Accounts Operations;
  16. Maintain communication with the Department of Information Technology Services (ITS) on the operation of the SHI programs including coordination on maintenance requirements and program enhancement;
  17. Serve as designated Regional Insurance Officer;
  18. Monitor the processing of claims submitted to the Advisory Committee on Compensation Claims (ACCC) for accident and disability claims, coordinating benefits, as required;
  19. Perform other related duties, as assigned.

REQUIRED QUALIFICATIONS

Education:

Essential: Abachelor’s degree in business administration, insurance, public health administration or any other field related to the functions of the post from a recognized university.

Desirable:  A master’s degree in business administration, health services administration or public health administration would be an asset.

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/. PAHO will also use the databases of the Council for Higher Education Accreditation http://www.chea.org and College Navigator, found on the website of the National Centre for Educational Statistics, https://nces.ed.gov/collegenavigator to support the validation process.

Experience :

Essential :   Seven years of national and international experience in analysis and finance with emphasis on insurance administration in the private or public sector, including at least two years of supervisory experience.

Desirable :  Managerial experience in health care insurance programs such as hospital and/or pension administration would be an asset.

Languages :

Very good knowledge of English or Spanish with a working knowledge of the other language. Knowledge of French and/or Portuguese would be an asset.

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Application deadline : March 07th, 2023