Assistant (Insurance), Geneva, Switzerland
Organization: World Health Organization (WHO)
City: Geneva, Switzerland
Office: WHO Geneva, Switzerland
Closing date: Tuesday, 8 September 2020
( 2002469 )
Grade : G3
Contractual Arrangement : Fixed-term appointment
Contract Duration (Years, Months, Days) : 2 years
Job Posting: Aug 18, 2020, 1:55:39 PM
The Department of Finance ensures that the financial management framework provides the required financial controls, reporting systems and procedures to meet the Organization’s needs. It is therefore responsible for WHO’s accounting policy and systems, corporate accounting, financial reporting, income and expenditure, donor accounting and reporting and treasury management policies. The Department of Finance has also the responsibility for SHI.
DESCRIPTION OF DUTIES
Under the direct supervision of the SHI Claims Management Officer the incumbent is assigned to: The receipt and processing of health insurance claims for reimbursement.
Participates in checking online or paper medical claims submitted by active and retired staff or their survivors in accordance with the rules of the SHI and the interpretation made by the SHI Global Standing Committee (SHI/GSC).
Assists in checking that proof of payment is provided in support of claims for reimbursement; verifies bank accounts and postal addresses; checks that bills are submitted within established time limits; checks the 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, or when case is over USD15,000 or complex, escalates the claim to supervisor or seek advice to the Medical Adviser; verifies entitlement to coverage or further action; in the case of hospitalization.
Prepares input documents for the processing of claims by computer.
Enters and processes daily claims through the HIIS system.
Performs all other related duties as assigned.
B. 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. Perform all other related duties as assigned.
Essential: Graduation from a secondary school or equivalent.
Desirable: Higher education an advantage.
Essential: At least 2 years administrative experience in an administrative/office environment which is a service-oriented environment.
Desirable: Experience in UN-system health insurance and/or other commercial health insurance company. Multicounty/international experience and in-depth experience in : WHO/UN or other organization, SHI rules, staff rules, financial regulations of WHO, Swiss and French Medical Procedure/supply codes
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 to management. Incumbent must be able to work independently and in a team and work in the up most of confidentiality.
Respecting and promoting individual and cultural differences
Knowing and managing yourself
Use of Language Skills
Essential: Intermediate knowledge of English. Expert knowledge of French.
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 63,015 (subject to mandatory deductions for pension contributions and health insurance, as applicable) and 30 days of annual leave.
This vacancy notice may be used to fill other similar positions at the same grade level
Only candidates under serious consideration will be contacted.
Tags accounting and reporting financial management financial regulations financial reporting physician
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’s workforce adheres to the WHO Values Charter and is committed to put the WHO Values into practice.
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.