Insurers and TPA Compliance Specialist
Doha Qatar
منذ 4 يوم
source : HireeJobsGulf

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 riskbased 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 noncompliance 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 noncompliance 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 noncompliance 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 noncompliance 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 recordkeeping and audit trails are maintained 12 Operate on a riskbased annual Programme 13 Recommend or complete onsite inspections where necessary and 14 Write and present reports on investigations where noncompliance 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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