OBJECTIVE OF THE OFFICE/DEPARTMENT

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:

• 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;
• 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;
• 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;
• Prepare, coordinate, and conduct workshops for active and retired staff members on insurance benefits and requirements, case management alternatives, and cost savings opportunities;
• Review selected medical charges for conformance with usual and customary medical costs for similar services and initiate inquiries where required;
• 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;
• 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;
• 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;
• 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;
• 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;
• Identify claims irregularities, initiate special reviews and provide findings and recommendations to the Administration and in accordance with relevant policies and procedures;
• Monitor the status of SHI Accounts Receivables including the initiation of follow-up correspondence and collection action;
• 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);
• 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;
• 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;
• 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;
• Serve as designated Regional Insurance Officer;
• Monitor the processing of claims submitted to the Advisory Committee on Compensation Claims (ACCC) for accident and disability claims, coordinating benefits, as required;
• Perform other related duties, as assigned.

REQUIRED QUALIFICATIONS

Education:

• Essential: A bachelor’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).

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.

SKILLS:

PAHO Competencies:

• Overall attitude at work: Maintains integrity and takes a clear ethical approach and stance; demonstrates commitment to the Organization’s mandate and promotes the values of the Organization in daily work and behavior; is accountable for work carried out in line with own role and responsibilities; is respectful towards, and trusted by, colleagues and counterparts.
• Teamwork: Collaborate and cooperate with others/Deal effectively with conflict - Creates team spirit; promotes collaboration and open communication in the team; proactively supports others; welcomes team responsibilities and drives team results; promotes knowledge sharing in the team.  Proactively identifies conflicts and facilitates their resolution in a respectful manner; tactfully resolves conflicts between or with others and takes action to reduce any possible tension; effectively builds a rapport with individuals and teams, establishing good personal and professional relationships, as well as minimizing risk of potential conflict.
• Respecting and promoting individual and cultural differences:  Relate well to diversity in others and capitalize on such diversity - Treats all people with dignity and respect. Relates well to people with different cultures, gender, orientations, backgrounds and/or positions; examines own behavior to avoid stereotypical responses; considers issues from the perspective of others and values their diversity.
• Communication: Express oneself clearly when speaking/Listen/Write effectively/Share knowledge - Foresees communication needs of audience and targets message accordingly.  Facilitates open communication; encourages others to share their views openly and takes time to understand and consider their views.  Writes down ideas in a clear, structured, logical and credible way; drafts and supports the development of guidelines, policies and procedures.  Shares relevant information openly and ensures that the shared information is understood; considers knowledge sharing as a constructive working method and demonstrates awareness of the Organization.
• Producing Results:  Work efficiently and independently/Deliver quality results/Take responsibility - Prioritizes work, monitors own progress against objectives and adapts plans as required; communicates adjustments as necessary. Acts proactively and stimulates action as needed; handles problems effectively and constructively. Produces high-quality results and workable solutions that meet clients’ needs. Works independently to produce new results and sets own time lines effectively and efficiently.  Shows awareness of own role and clarifies roles of team members in relation to project’s expected results. Makes proposals for improving processes as required and takes responsibility for own work and/or actions, as necessary.  Demonstrates positive attitude in working on new projects and initiatives. Demonstrates accountability for own success, as well as for errors; learns from experience.
• Moving forward in a changing environment: Propose change/Adapt to change - Actively supports Organizational change initiatives and demonstrates personal commitment to them, including when faced with new demands; proposes workable solutions to challenging situations.  Engages in positive responses to a changing environment and promotes workable solutions to achieve own and team’s results.  Welcomes, and actively seeks to apply, new ideas, approaches and working methods and technologies in order to improve own and/or team’s work processes and results; demonstrates commitment to Organizational change initiatives.

Technical Expertise:

• Specialized knowledge of health care insurance programs or hospital administration and/or pension administration.
• Strong knowledge of health insurance administration including claims administration and management in the health insurance area and in the evaluation and selection of cost-effective insurance plans; knowledge of the full range of insurance options and cost alternatives.
• A strong knowledge of accounting principles and practices.
• A strong knowledge of the Staff Health Insurance Rules.
• Ability to establish and maintain effective working relationships with internal and external clients using principles of good customer service.
• Ability to supervise staff and provide training and to develop work and business plans.
• Strong professional oral and writing skills, including the development of reports, oral presentations, and technical/persuasive documents for consideration at the highest levels of the Organization.

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.

IT Skills:

• Demonstrated ability to effectively use current technology and software, spreadsheets and presentations, as well as Enterprise Resource Planning (ERP) and management information systems. Other IT skills and knowledge of software programs such as Microsoft Excel, Outlook, OneDrive, PowerPoint, Teams, SharePoint, and Word are considered essential.

Source: https://careers.who.int/careersection/ex/jobdetail.ftl?job=2301546&tz=GMT%2B05%3A30&tzname=Asia%2FCalcutta