About the job
Responsible for the on-time completion of activities related to Policy & Procedure (P&P) development and implications for the implementation of mandatory health insurance scheme of the client.
- Participates in the design, development, and delivery of Policy & Procedure (P&P) related to health insurance scheme
- Understanding of the health insurance ecosystem – insurance companies, healthcare providers, third party administrator
- Close co-ordination with the client to devise a policy framework that achieve long-terms goals and is responsive to dynamic development
- Policies and procedures development
- Benchmark the P&Ps and standards of all the regulatory and compliance functions that the client is required to enforce to meet the best international practice whilst adhering to regional norms
- Develop all the regulatory requirements of the scheme, including updating the existing P&Ps and conceptualizing new requirements as defined in this RFP, and as the consultant deems necessary.
- This deliverable is expected to cover the following, but not limited to, P&Ps:
- P&Ps for enrollment of targeted population in the Scheme in a phased manner.
- P&Ps for compliance of all stakeholders with the regulatory framework of the health insurance scheme
- P&Ps for governance, grievance redressal, appellate process
- Confidentiality clauses for the purpose of registration, enrollment, healthcare provision, claims management, data transmission & reporting, and other processes (Key deliverable).
- Policies to co-ordinate the coverage and provision of health care services between mandatory health insurance and complementary / supplementary health insurance. Any other P&Ps as desired by the Client or deemed purposeful by the Consultant
- Policy implications
- Provide expert advice on the impact of policies related to the implementation of the Scheme on the public and private health care providers, insurance companies, public and private employers, recruiters, and the population (visitors, expatriates, and nationals) as a whole.
- Provide client with a holistic picture of the implications of each option / policy that would assist the Ministry/Government in priority setting and effective decision-making.
- A minimum of 15 years of multinational experience in the development and implementation of health insurance schemes at a regulatory level in general
- Works willingly and effectively with others in and across the team to accomplish project goals.
- Ability to manage multiple projects, juggle priorities and deliver on tight deadlines.
- Working knowledge or familiarity with the health insurance ecosystem of Middle East
- Language: Exceptional command over English is a must. Knowledge of Arabic is an advantage.