OBJECTIVES OF THE PROGRAMME
The Department of Finance ensures that the financial management framework provides the required financial controls, reporting systems and procedures to mee 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 insurance and pension services including administration of operations and risk management relating to staff and other financial risks.
DESCRIPTION OF DUTIES
Under the general supervision of Administrative Officer, SHI the incumbent is assigned to the receipt and processing of health insurance claims, including those involving the direct payment to physicians, hospitals and others on behalf of claimants. The incumbent also assists in analysing the accounts of the Staff Health Insurance, preparing reports, graphs, etc.
Medical Claims (75%):
- Examining medical claims submitted by active and retired staff or their survivors in accordance with the rules of the Staff Health Insurance and the interpretation made by the Headquarters Surveillance Committee, in particular: ensures that proof of payment is provided in support of claims for reimbursement, verifies bank accounts and postal addresses; 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; verities 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.
- Prepares input documents for the processing of claims by computer.
- Enters and validates daily claims on computer.
- Contacts and/or prepares correspondence to medical providers, i.e. physicians, dentists, clinics, laboratories, etc. concerning medical claims/payment requests.
- Receives active and retired staff to provide information on claims.
- Validates claims pre-coded by regions and processes payment.
- Back-up to persons doing direct payments.
Financial Accounting/Analysis (15%)
- Prepares financial reports and statements.
- Compiles and assists in analysing statistics using graphs to illustrate trends, etc.
C. SHI Payment 5%
- Back up for the SHI person(s) responsible for the tri-monthly payment (value US$ 2 m approx..) - verifies the exchange rate in the HIIS database corresponds to the official UN rate for the month. Ensures that all RO data has been received and processed by the team. Distributes a list of special “approvals” to the team, ensures that they are verified and approved by the supervisor. Reviews the different error reports - invalid/erroneous/not yet validated claims, mock payment and ensures that the team members take corrective action and ensures that all requests for reimbursement are in the system ready for payment. Reviews the high cost requests, checks and verifies with the team and has approved by the supervisor. Initiates the payment process in the database (no. voucher, batches, dates) and begins to make the calculations of the payments. Checks all of the accounts for the payment and reconciles any errors by making manual payment vouchers. Once all is reconciled and the claims are ready for payment , requests signature of supervisor and sends electronically to GSD. Prints all payment advices for HQ and Regions and ensures that they are placed in envelopes and dispatched appropriately.
D. Other (10%) - other duties as required.
- Essential: Completion of secondary school education or equivalent.
- Desirable: Higher education an advantage.
- Essential: A minimum of 8 years administrative experience.
- Desirable: Experience in health care insurance related activity, preferably involving a multi country network would be an asset.
In-depth knowledge of : 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, excessive billing or other anomalies are dealt with under supervision and in absolute confidentiality
- Knowing and managing yourself
- Producing results
Use of Language Skills
- Essential: Expert knowledge of English. Expert knowledge of French.
- Desirable: Expert knowledge of another WHO official language.