Claims Management Officer

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Position Title: Claims Management Officer
Location: New Delhi
Country: India
Deadline Date: Not specified

Job Details

Job Posting Organization:
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. Established on April 7, 1948, WHO has a mission to promote health, keep the world safe, and serve vulnerable populations. With over 7,000 employees, WHO operates in more than 150 countries, working to combat diseases, improve health systems, and respond to health emergencies. The organization emphasizes the importance of health equity and aims to ensure that everyone can attain the highest possible level of health.

Job Overview:
The Claims Management Officer will be responsible for managing health insurance claims for WHO staff and participants. This role involves scrutinizing claims, ensuring compliance with health insurance policies, and facilitating timely reimbursements. The incumbent will work closely with healthcare providers and participants to resolve issues related to claims and provide guidance on health insurance policies. The position requires a strong understanding of medical terminology and insurance practices, as well as excellent organizational and communication skills. The officer will also play a key role in maintaining the Health Care Provider (HCP) network and ensuring compliance with established standards.

Duties and Responsibilities:

• Claims Management: Review and process health insurance claims, ensuring all required documentation is accurate and complete. Enter claims into the Health Insurance Input System (HIIS) and ensure timely reimbursement. Communicate with healthcare providers and participants to verify claims and resolve issues. Prepare letters of guarantee for hospitalization and maintain logs related to HCPs.
• Health Care Provider Network: Identify and maintain relationships with key healthcare providers, ensuring updated contracts and price lists. Facilitate agreements for discounted rates for participants.
• Compliance Risk and Fraud Prevention: Monitor claims for compliance with established standards and identify potential fraud. Discuss high-cost claims with participants and report suspicious cases.
• Case Management and Cost Containment: Work with the SHI Medical Adviser to manage cases and identify opportunities for cost reduction. Ensure claims are processed in accordance with SHI rules and regulations.

Required Qualifications:
Essential: Completion of secondary school education. Desirable: University degree or diploma in pharmacy, health sciences, business administration, or accounting. Candidates should possess knowledge of pharmaceutical products, medical terminology, and the laws governing medical insurance. Strong organizational skills and the ability to prioritize tasks are essential, along with a client service orientation and the ability to handle confidential matters with discretion.

Educational Background:
Candidates must have completed secondary school education as a minimum requirement. A university degree or diploma in relevant fields such as pharmacy, health sciences, business administration, or accounting is desirable and will enhance the candidate's qualifications for the role.

Experience:
Candidates should have at least 5 years of progressively responsible experience in insurance, administration, or accounting. Experience working with a diverse clientele, including both national and expatriate staff, is highly desirable. This experience should demonstrate the ability to manage claims effectively and provide excellent client service.

Languages:
Excellent knowledge of English is essential for this position. Proficiency in additional languages may be considered an asset but is not mandatory.

Additional Notes:
The position offers an attractive remuneration package, including an annual net base salary starting at INR 1,078,604, subject to mandatory deductions. Staff members are entitled to 30 days of annual leave. The vacancy notice may be used to fill other similar positions at the same grade level. Candidates under serious consideration will be contacted, and a written test or video assessment may be part of the screening process. WHO is committed to diversity and inclusion, encouraging applications from women, persons with disabilities, and nationals of underrepresented Member States. The successful candidate will be required to provide evidence of vaccination as per WHO requirements.