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Senior Health Insurance Specialist

Company Overview

Palladium is a global leader in the design, development and delivery of Positive Impact - the intentional creation of enduring social and economic value. We work with foundations, investors, governments, corporations, communities and civil society to formulate strategies and implement solutions that generate lasting social, environmental and financial benefits.

For the past 50 years, we have been making Positive Impact possible. With a team of more than 2,500 employees operating in 90 plus countries and a global network of more than 35,000 technical experts, Palladium has improved - and is committed to continuing to improve - economies, societies and most importantly, people's lives.

Palladium is a child-safe organisation, and screens applicants for suitability to work with children. We also provide equal employment to all participants and employees without regard to race, color, religion, gender, age, disability, sexual orientation, veteran or marital status.

Project Overview and Role

The Senior Health Insurance Specialist plays a key role on health insurance issues that lead to improved equity, access, coverage, resource allocation, and quality of health services through policy dialogue informed by sound evidence, systematic learning, and capacity building. S/he provides technical expertise and training for the Ministry of Public Health in all areas of health insurance, including the formulation, design of health insurance policies and regulations and Implementation of health insurance in Afghanistan.

The Senior Health Insurance Specialist works on the Health Sector Resiliency (HSR) Project to development and expand the project's technical advisory services to the Ministry of Public Health. S/he increases knowledge and understanding of health insurance principles and implementation through dissemination of evidence-based work; publications in journals; presentations to donors, stakeholders, and other development partners; and at conferences.

The Senior Health Insurance Specialist collaborates with health team members on health financing work across the spectrum of forms of health insurance including universal health coverage, social health insurance, community-based health insurance, private health insurance and other forms of health insurance.

Responsibilities

  • Provide technical leadership, training and technical assistance for MOPH in health insurance.
  • Undertake assessments, design, implementation, and evaluation of health insurance.
  • Direct and manage effective analytic and normative policy work as well as support for technical support to the implementation of health insurance.
  • Lead the development of strategic assessment, planning and management in health insurance.
  • Lead the writing and submission of the necessary enabling legislation and regulations which must be passed by the government for creating and regulation health insurance.
  • Develop and maintain strong working relationships with a wide range of stakeholders, partners, and collaborators in health insurance including various ministries and private organizations to develop and implement health insurance components into existing health system.
  • Assist with the development of specific health insurance schemes that have been developed and accepted by ministry of health.
  • Develop and conduct areas of operational research on health insurance topics.
  • Develop and publish peer-reviewed articles on health insurance.
  • Represent the organization at domestic and international meetings in making presentations to donors and development partners.

Requirements

  • Advanced graduate degree in health economics and financing and specialized training in health insurance. Minimum of 8 years of relevant work experience at international level in health insurance in developing countries.
  • Significant and successful experience in providing technical assistance in the development, design, implementation, and evaluation of health insurance schemes in developing countries including private and public insurance schemes.
  • Internationally recognized expertise and experience in health insurance assessment, design, implementation, and evaluation of health economics and financing policies using various tools including modeling, costing, cost-effectiveness analysis, efficiency assessments, and value-for-money and impact evaluation.
  • Have basic knowledge concerning key health insurance design and implementation issues in following areas
    • Policy Objectives for health insurance:
      • The nature of insurance and the variations in form (mandatory, voluntary, statutory)
      • How can the relationship to the other sectors be organized?
      • How can social insurance promote national health policy objectives?
      • What is your long run objective and how does health insurance fit into this?
    • 2. Population Coverage:
      • Who can and will be covered?
      • Is coverage mandatory?
      • What are the equity implications of limited population coverage and how can it be extended?
    • 3. Access and Utilization of Services (Entitlements)
      • What will be the range of benefits covered and is known of their cost-effectiveness?
      • How does social insurance affect access to and utilization of services?
      • Who is a qualified provider?
      • How do you set qualification standards?
    • 4.Organization of Health Services:
      • What is the most efficient organizational and administrative structure for the delivery system?
      • What is the relationship between the insurers and providers (independent or part of the system)?
      • What is the role of the different institutions in the scheme? (Ministry of health, social insurance, provider organizations, etc.)
    • 5.Payment mechanisms:
      • What are the alternative methods for paying health care providers and hospitals and the inherent incentives of the payment mechanism?
      • What are the utilization incentives for the insured population based on the benefits package and the premiums?
      • Will there be a single funding agency or several?
    • 6.Cost estimating and financing:
      • How much would the various alternative plans cost?
      • What will be the distribution of the financing burden?
      • What are the long-run costs?
    • 7.Administration and Management of health insurance:
      • Data requirements for administering a health insurance scheme
      • How will the following be organized?
      • registration of insured and covered persons
      • collection of contributions
      • handling of claims
      • payment to providers:
      • Will providers be dependent or independent?
      • Will costs be reimbursed or service provided on a contract basis?
      • How will the payment system be developed to minimize fraud and verify that services claimed were delivered?
      • utilization, performance and quality control
    • 8.Building Consensus and Acceptability
      • How to build support among the proposed insured, provider, and insurer groups.
    • 9.Developing and writing the necessary enabling legislation and regulations required to oversee and regulate health insurance.
    • 10.Able to establish the necessary management information systems needed for health insurance implementation and oversight.
    • 11. Able to help the government negotiate elements of health insurance oepraiton including, but not limited to:
  • PROVIDER ISSUES
    • fees & fee negotiations
    • contracts
    • reimbursement/purchases
  • MEMBERS
    • enrollment
    • claims process and administration
  • REVENUE
    • collection
    • premiums
  • OTHER NECESSARY CONTRACTS
  • CLAIMS PROCESSING IF NOT ON CAPITATION BASIS
  • Experience and skills in health insurance, financial and economic modeling, regulations and analysis of health insurance programs.
  • Demonstrated success in leading, managing and coordinating analytical assessment, policy formulation, developing necessary insurance regulations and implementing health insurance schemes with ministries of health in developing countries.
  • Publications in established peer-viewed journals and presentations at international conferences on health insurance.
  • Extensive experience in providing capacity-building training in developing countries.
  • Good interpersonal and relationship-building competencies in both developed and developing country settings coupled with strong written and oral communication skills.
  • Good understanding and experience of working in developing countries.
  • Energetic, forward thinking, independent, creative person with intellectual depth and high ethical standards.
  • Fluency in English required, working professional knowledge of Dari language would be helpful.