Insurers and TPA Compliance Specialist
iHorizons
Qatar,Qatar,Qatar
منذ 4 يوم
source : drjobs.ae

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; and14. 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.

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