Technical Assistant – for Claims management Directorate, Ethiopia

Job Description

Purpose 

Purpose: The Technical Advisor will be seconded and accountable to the Claims Management Directorate of the Ethiopian Health Insurance Service and work closely with the team leaders and experts. Moreover, the technical assistant will closely work with relevant directorates to align and improve the overall health insurance management system. Besides, the TA is expected to work with and provide support to branch offices.

Location: MoH

Duration:12 months but extendable depending on the satisfactory performance

No. of consultants: One (#1)

Start Date: July 2023

Reporting to: Claims Management Directorate/MoH and UNICEF

Background:

As part of universal health coverage, Ethiopia aims to promote financial risk protection through implementation of risk pooling mechanisms. To this end, the government designed to implement two types of health insurance schemes: Social Health Insurance (SHI) which aims and targets formal sector employees and Community Health Insurance (CBHI) which aims and targets communities who are in the informal sector mainly residing in rural, pastoral, semi pastoral areas, and urban dwellers who make their life not out of formal employment.   

CBHI system implementation was started as a pilot program in 2011 in thirteen woredas. Currently, the number of Woredas implementing CBHI has reached to 916, while the total number of households enrolled in CBHI schemes has reached more than 11.3 million of which 2 million members are indigents. Besides more than 3000 health facilities are contracted to deliver health services to the beneficiaries. Various program reviews and studies have shown that CBHI has helped in improving health service utilization, availing more revenue for facilities that could be used for healthcare quality improvement, in reducing financial hardship and enabling women's empowerment. The routine report shows that the per capita health service utilization in CBHI woredas has increased from 0.36 in 2015 to 1.2 in 2021.

Furthermore, the CBHI impact study report which was conducted in 2021 showed that per capita health service utilization for CBHI members has increased to 2.03.

To further strengthen health insurance system, the Ethiopian Health Insurance service provided due emphasis in its five-year strategic plan and set ambitious goals and targets to expand CBHI to 85 percent of Woredas of the nation and enroll 80 percent of the eligible Households by the year 2024/25. Moreover, it has planned to smoothly roll out Social Health Insurance.

Hence, to ensure effective implementation of the health insurance system and meeting the envisioned strategic objectives and targets set at all levels: it is crucial to build the capacity of claims management directorate to put in place strong and efficient claims management system, to provide strategic direction, as well as to overcome technical and operational challenges going to be encountered.

Therefore, EHIS is looking to recruit competent candidates who can be able to provide technical assistance to the directorate.

Purpose of the position:

The Technical Advisor will be seconded and accountable to the Claims Management Directorate of the Ethiopian Health Insurance Service and work closely with the team leaders and experts. Moreover, the technical assistant will closely work with relevant directorates to align and improve the overall health insurance management system. Besides, the TA is expected to work with and provide support to branch offices.

Specific Tasks:

•   Review and design efficient claims management processes, 
•   Assess and design strategies to mitigate risk associated with claim data set,
  
•   Support in designing and enhancing claim management system,
  
•  Support to improve the practice of timely, accurate and efficient reimbursement of claim datasets,
  
•   Design strategies to prevent, detect and mitigate claim fraud,
  
• support the analysis of a huge claim data set,
  
•  Support to develop standardized tools, procedures, and manuals to improve the claims management system,
  
•   Produce analytic reports on a regular basis, and propose policy-level recommendations,
  
•  Develop a dashboard to enhance cost containment,
  
• Set up systems to facilitate monitoring and early identification of problematic areas, work with the team members to address challenges,
  
•  Build the technical capacity of staff through day-to-day support,
  
•    Develop capacity-building modules and provide training to regional implementers and healthcare providers,
  
•  Provide technical support for branch offices,
  
•  Perform other duties and responsibilities as requested by the directorate.
  

Reporting:

The technical Assistant – for Claims management will be directly recruited byABH Partners Plc and will report to the Claims management directorate at MoH & also to the Immunization team at the UNICEF country office.

Payment Modality & schedule:

The fees for this contract shall be paid on a monthly basis based on the submission of monthly reports against the deliverables indicated above.

Job Requirement

Expected educational background and experience:

Post Graduate Degree in health economics, public health, or medicine. The applicant should have at least 10 years of experience of which at least five years’ experience in the area of health insurance/ health financing.

Core competencies:

• Experiences in clinical areas,
• Experiences in medical/clinical auditing,
• Experience working in health insurance systems/health financing,
• Experience in health program mentorship,
• Experiences in program monitoring, identifying, analyzing, and solving problems,
• Strong communication skills, including delivery of compelling presentations and documents,
•  Strong interpersonal skills and ability to achieve consensus amongst stakeholders,
•  Ability to work independently, set priorities and handle multiple tasks simultaneously,
• Ability to learn on the job quickly and absorb and synthesize a broad range of information,
• Computer skill including Ms-excel, Ms-word, Ms-PPT etc.

Note:

•        The consultants will be based at MoH level
  

• The consultant will use his/her own materials, i.e., computer/laptop, phone, etc.
• For the duty travel, the consultant will be provided a vehicle and DSA from the assigned government counterpart/MoH as per the guideline.

•   The consultant will be paid monthly by ABH Partners Plc  upon completion of deliverables as indicated on this TOR and approved by the supervisor
  

Policy both parties should be aware of:

•   ABH Partners Plc will manage all the administrative issues and aspects based on HR policies and procedures.
•   All remuneration must be within the contract agreement through ABH Partners Plc.
•  No contract may commence unless the contract is signed by both ABH Partners Plc and the consultant.
•   Travel will be facilitated and managed in agreement with MoH.
• Consultants will not have supervisory responsibilities or authority on the UNICEF budget