Insurers and TPA Compliance Specialist
iHorizons
قطر
منذ 6 يوم
source : tanqeeb

Position Summary :

The Insurers and TPA Compliance Specialist will be responsible for overseeing the compliance of a set of regulated bodies in this case Private Health Insurers (PHI), Third Party Administrators (TPA) and Intermediaries and Brokers with a range of regulatory standards set for them by the SHIS.

They will need to develop a detailed knowledge of the standards set by the SHIS that bodies who wish to operate within the SHIS must comply with, and to use data to explore and determine whether bodies are actually compliant with those standards or not.

As such, the role of the Insurers and TPA Compliance Specialist has a vital role in ensuring that the sector complies with the SHIS’ key regulatory standards.

The Insurers and TPA Compliance Specialist will manage a portfolio of PHIs, TPAs and Intermediaries and Brokers who operate within the SHIS.

  • They will manage their portfolio on a risk-based approach, reviewing the regular submissions of information required and provided;
  • work with other regulatory bodies to assist in monitoring where required. They will escalate any significant breaches of compliance to the Head of Health Insurance Compliance and lead on any investigations and take enforcement actions.

    They will review submitted action plans received from regulated bodies where non-compliance has been found. They will review enforcement to ensure organizations improve and remain compliant.

    They will monitor the overall health insurance market to identify potential trends in non-compliance. Where potential trends are identified they will work with the Finance Team to conduct market investigations.

    Nature and Scope of Position :

  • 1. Maintain overall responsibility for the monitoring of relevant regulated bodies within the SHIS;
  • 2. Understand the regulatory standards for relevant regulated bodies set by the SHIS in detail, and remain up to date with any changes to or developments of those standards;
  • 3. Educate less experienced colleagues of the Health Insurance Department (HID) on the appropriate approaches to the regulation of PHIs, TPAs and Brokers and Intermediaries according to the HID’s regulatory standards;
  • 4. Notify the Head of Health Insurance Compliance Section where non-compliance is found and investigate accordingly;
  • 5. Recommend when relevant regulated bodies are to be added or removed from the Risk Register;
  • 6. Build and maintain strong working relationships with stakeholders both internally and externally;
  • 7. Complete investigations into non-compliance against the HID’s standards;
  • 8. Deliver individual workload as well as working flexibly as part of a team, undertaking tasks as required;
  • 9. Ensure appropriate agreed methodologies are followed;
  • 10. Assess and analyze information received from a variety of channels;
  • 11. Update relevant databases and records to ensure accurate record-keeping and audit trails are maintained;
  • 12. Operate on a risk-based annual Programme;
  • 13. Recommend or complete on-site inspections where necessary; and

    14. Write and present reports on investigations where non-compliance has been found.

    15. The incumbent will be making local and international phone calls during and outside of the working hours, as necessary in order to facilitate and expedite outcomes.

    16. The incumbent will be attending meetings, conferences and workshops, and give presentations to address any issue related to his / her job, whether within the premises of Client or in any locations within Qatar, or even internationally.

    Skills

    Should be Arabic Speaker / National

    Should be currently working for a TPI Company.

    Knowledge, Skills and Experience Required :

    Skills, knowledge and abilities normally acquired through :

    Formal Education Requirement

  • Master’s Degree in Business Administration / legal qualification or equivalent; and
  • Batchelor’s Degree in related field (e.g. business management, regulation, public policy or other equivalent).
  • Experience Requirements :

  • Minimum 5 to 7 years’ experience in a similar role in an insurance setting or regulatory environment;
  • Experience in a regulatory environment with responsibility for enforcement action; and
  • Requires significant knowledge of healthcare and / or insurance regulation in order to advise on the compliance and enforcement of insurance providers.
  • Knowledge of health care regulatory policies;
  • Knowledge of research, analysis and reporting methods;
  • Knowledge of and ability to utilize conflict resolution and problem solving techniques;
  • Ability to analyse and interpret legal and contractual language;
  • Ability to communicate effectively, both orally and written;
  • Ability to effectively prioritize multiple tasks and deadlines;
  • Skill requirement

  • Ability to analyse large volumes of data and information logically;
  • Ability to work as part of a team;
  • Ability to work to deadlines;
  • Ability to establish and maintain effective working relationships with professional colleagues, public and private sector officials and regional professionals; and

    Knowledge of health insurance.

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