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- Participate in the design, development, and testing of new control/compliance modules, facilities, and interfaces for the SHI (Health Insurance Information System (HIIS) and SHI-Online (or other SHI systems) related to compliance of SHI claims in collaboration with Head SHI and Quality Assurance and Risk Management Officer.
- Ensure user's requests are captured, monitored and dealt with in an efficient and timely manner and that the claims team are fully briefed on changes to controls in the SHI systems.
- Ensure that Information Notes are prepared on compliance as and when necessary.
- Assess application of control measures in the processing of SHI claims, in part through performing regular spot checks of claims and proposes appropriate measures to ensure business continuity, confidentiality, and data protection.
- Implement global verification mechanisms for SHI claims, prior to clearance for payment during the validation stage, including spot checks. Identify, address and provide support on compliance and risk issues in collaboration with SHI teams.
- Keep abreast of and evaluate new technologies and tools that could potentially improve the products in the assigned domains for compliance of SHI claims.
- Follow upon open internal and external audit reports in relation to compliance of SHI claims with the Quality Assurance and Risk Management Officer and assist managers in implementing audit recommendations and rectifying control weaknesses as needed.
- Participate in compliance reviews when requested by the Office of Internal Oversight Services (IOS).
- Fraud in consultation with Head SHI and the Quality Assurance and Risk Management Officer, conduct initial assessments and prepare case files, for handover to IOS, when a suspicious or irregular case is identified.
- Support the Organization's efforts to implement proactive measures to prevent, prepare and respond to fraud in SHI processes and operations.
- Perform all other related duties as required.
- University degree (Bachelor's degree or equivalent) in health administration, insurance, audit, compliance or related field.
- A relevant technical diploma or certification in health insurance, insurance, audit, risk and compliance.
- At least two years of experience in relevant health care administration functions, health insurance or insurance environment.
- At least 1-2 years medical or related insurance claims adjudication experience.
- Experience in an international health insurance environment.
- Experience in working with outsourced service providers.
- Knowledge of internal control and audit principles and their application in the context of health insurance SHI.
- Excellent knowledge in the area of health insurance sector.
- Excellent knowledge of compliance processes and financial audits.
- Quality focused with excellent analytical - and creative problem-solving skills, sound judgment and attention to detail.
- Excellent interpersonal skills.
- Ability to work with minimal guidance/supervision and prioritize own workload in a time-constrained environment.
- Positive attitude to learning new skills and adapt to new technologies.
- Ability to work well as part of a team in a multicultural environment.
- Ability to communicate clearly and concisely, in oral and writing.
- Knowledge of health insurance processes and systems.
- Knowledge of WHO Financial Regulations and Financial Rules, SHI Rules, WHO procedures and practices.
- Applied knowledge of Power BI applications and tools.
- Applied knowledge of the ERP systems (Oracle or Workday preferred).
- Applied knowledge of MS SharePoint.
- Knowledge of the staff health insurance programmes of the various UN agencies.
- Teamwork
- Respecting and promoting individual and cultural differences
- Communication
- Producing results
- Moving forward in a changing environment
- Expert knowledge of English.
- Expert knowledge of French.
- Expert knowledge of Spanish.
Compliance Officer SHI - Geneva, Schweiz - WHO
Beschreibung
DESCRIPTION OF DUTIES
Compliance
Audit
REQUIRED QUALIFICATIONS
Education
Essential :
Desirable :
Experience
Essential :
Desirable :
Skills
Essential Knowledge and skills
Desirable Knowledge and Skills
WHO Competencies
Use of Language Skills
Essential :
Desirable :