Specialist - Insurance - National Health Authority

1. POSITIONS VACANT: Specialist - Insurance (S-INS), National Health Authority (NHA), MoHFW, GoI (One Vacancy)

2. ORGANIZATION BACKGROUND:

National Health Authority (NHA) is the apex body, responsible for implementing Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), India's flagship health assurance scheme, providing health cover of Rs. 5 lakhs per family, per year, for secondary and tertiary care hospitalization, to over 10.74 crore poor and vulnerable families, or approximately 50 crore beneficiaries.

NHA is tasked with implementing PM-JAY at the national level.

State Health Agencies (SHAs) have been instituted by concerned states to implement PM-JAY at the state level. SHAs have full operational autonomy to implement PM-JAY in their state.

Key Functions of NHA

Key functions of the NHA include the following:

(1) Formulation of operational guidelines, model documents and contracts, to ensure standardization and interoperability of PM-JAY;

(2) Effective implementation and regular monitoring of PM-JAY, across the country, including initiation of suitable action for course correction, as necessary;

(3) Coordination with various State Governments on a regular basis for implementing PM-JAY;

(4) Acting as an apex body for SHAs that have been set up to implement PM-JAY.

For more information about NHA, please visit https://pmjay.gov.in/about/nha

3. JOB DESCRIPTION/ RESPONSIBILITIES:

Reporting to the General Manager (Operations), the Specialist - Insurance, shall be responsible for managing all functions related to TPAs and Claims Adjudication.

Key Job Responsibilities:

(1) Monitoring of Insurance/ TPA and Claims Adjudication teams;

(2) Coordination with all stakeholders, including SHAs, TPAs and Insurance Operations;

(3) Preparation of claim adjudication guidelines and related documents;

(4) Review and analysis of Claims Data for queries, rejections, etc.;

(5) Preparation of weekly, monthly and yearly reports, as and when required;

(6) Coordination and liaison with other departments and organizations;

(7) Any other assignment / responsibility given by NHA.

4. QUALIFICATION, SKILLS AND EXPERIENCE:

Qualifications:

Essential:

(1) Bachelor's degree from a recognized University/ Institute;

(2) MBA/ PGDBM/ Master's in Public Health from a reputed and recognized university or institution.

Desirable:

Graduate or post graduate degree in medicine shall be an advantage.

Experience:

Essential:

Five years of experience in managing health insurance portfolio in Claims Operations, TPA Monitoring and Claims Adjudication.

Skills and Competencies:

(1) Must be familiar with the reporting and administrative requirements of insurance;

(2) Thorough knowledge and experience of health insurance claims to process;

(3) Fully aware of health insurance regulatory framework and guidelines;

(4) Demonstrate managerial skills for team management;

(5) Demonstrate skills for maintaining end to end delivery of insurance;

(6) Demonstrated training experience;

(7) Fluency in English and Hindi is necessary and working knowledge of Other languages is an advantage;

(8) Excellent communication and interpersonal skills;

(9) Demonstrated ability to work in a multicultural environment and establish harmonious and effective relationships with national partners;

(10) Demonstrated managerial and supervisory ability;

(11) The job may require frequent travelling hence the candidate should be willing to travel.

5. VACANCY DETAILS: One Vacancy

6. AGE LIMIT:

Not less than 30 years and not exceeding 45 years as on the last date of receipt of applications.

7. COMPENSATION OFFERED:

Gross remuneration budgeted for the position is Rs.1,25,000/- per month.

8. LOCATION: New Delhi, NHA Office.

9. CONTRACT TYPE AND PERIOD:

The post-holder shall be engaged on a consultancy contract, initially for a period of 12 months, extendable thereafter, on the basis of performance and approval by NHA.

10. REFERENCE: S-INS

11. CONTACT INFORMATION:

Team SAMS
Strategic Alliance Management Services P Ltd.
1/1B, Choudhary Hetram House, Bharat Nagar
New Friends Colony, New Delhi 110 025
Phone Nos.: 011-41011564/65; 4081 9900

12. LAST DATE FOR APPLICATIONS:

Eligible candidates interested in this position are requested to apply online at www.sams.co.in by or before August 16, 2020, 11:59:59 PM.

CORRIGENDUM :

The last date for receipt of completed application forms for the vacancy is extended up to August 16, 2020 (11:59:59 PM). Other terms and conditions related to the application process remain unchanged.

Please Note : Only information input by candidates into their online application form, shall be considered for the purposes of confirming eligibility and assessing their candidature. The CV document uploaded by candidates shall be considered to comprise supplementary information, only. Requests by candidates to consider supplementary information provided in the CV document for the purposes of determining eligibility or awarding assessment scores shall not be entertained. Applications submitted through non-online modes, shall be deemed invalid.