Membership and Claims Clerk

Introduction

The position is located in the secretariat of the Staff Health Insurance Fund (SHIF), within the Policy and Social Benefits Branch (HR/POL) of the Human Resources Development Department (HRD). The SHIF is a self-administered mutual insurance entity that aims to provide coverage of expenses related to medical treatment, services and supplies to ILO employees, retired staff and their family members.

The main role of the Membership and Affiliation Clerk position is to process affiliations of officials, their families as well as former officials and their surviving spouses in accordance with established SHIF policies, rules and procedures.

The position will report to the Executive Secretary of the SHIF and receives guidance from the Supervisor of the claims unit and other senior members of the team as appropriate.

Specific Duties

1. Operate the interface from the ILO ERP system (Integrated Resource Information System (IRIS) to the Health Insurance Information System (HIIS) and check that affiliation-related data for active insured members are accurate and up to date. Inform the supervisor of discrepancies and update the information as instructed.

2. Process special affiliation requests: e.g. officials on special leave, inter-agency staff movements, voluntarily insured persons in accordance with the relevant articles of the SHIF regulations. Inform the supervisor of discrepancies and update the information in the HIIS system as instructed. Enter data in the HIIS system relative to reimbursable expenses.

3. Process applications for After Service Health Insurance for the affiliation of former officials, disabled and widows or widowers, including beneficiaries of retirement and invalidity pensions, in accordance with the relevant articles of the SHIF regulations. Check eligibility requirements and perform standard calculations for individual SHIF contributions. Provide the information to the insured persons and update the necessary information in HIIS. Refer any special case to the supervisor for review.

4. Process affiliations for voluntarily covered dependants (children and spouses), in accordance with the relevant article of the SHIF regulations. Respond to general inquiries and share information on established procedures and eligibility requirements.

5. Prepare attestations of coverage using established templates and prepare appropriate standard responses to affiliation-related queries for supervisor’s signature/approval. Reply to routine requests for information by telephone, in writing, or at the SHIF information desk.

6. Assist with the processing of claims for reimbursement submitted by the insured persons and apply reimbursement rates and other coverage terms in accordance with the SHIF rules and established procedures. Refer any non-conform claims and/or irregularities to the Supervisor of the Reimbursement Unit and other senior members of the team as necessary.

7. Perform other relevant duties as assigned.

These specific duties are aligned with the relevant ILO generic job description, which includes the following generic duties:

Generic Duties

1. Obtain and verify information relating to requests from staff. Type personnel action forms as a result of adjustments, corrections or discontinuance of benefits or entitlements, and changes in status.

2. Review completed forms for proper entries and signatures. Check information provided by staff against payroll information, and return incomplete forms to staff for the required information.

3. Process computerised personnel actions, and prepare daily contracts.

4. Check applications for employment, refer those with the required qualifications to the supervisor, and draft appropriate standard responses to all such communications.

5. Schedule candidates for required testing, and notify applicants of test results.

6. Obtain necessary clearances and draft vacancy announcements in standard formats from information extracted from official job descriptions. Arrange for candidate interviews, training seminars, meetings, etc.

7. Maintain candidate rosters, training course information, vacancy lists, and personnel records. Contact appropriate sources to secure any missing items. Retrieve files and records as required.

8. Assist the supervisor in preparing slides and graphs for presentations.

Required qualifications

Education

Completion of secondary school or equivalent technical or commercial school.

Experience

At least three years of work experience in a social security administration/health insurance scheme at the national or international level would be an advantage. Knowledge of the SHIF regulations and administrative rules would be an advantage.

Languages

Excellent command of one official language (English, French, Spanish) of the Organization. Working knowledge of another official language of the Organization.

Competencies

In addition to the ILO core competencies, this position requires:

Technical

Knowledge of general HR procedures and rules. Ability to use relevant specialised computer databases. Ability to work as part of a team and with a minimum of supervision. Ability and skills to maintain official files and records. Drafting skills. Communication skills. Ability to work methodically with attention to detail. Acquaintance with health insurance administrative and information technology tools would be an advantage.

Behavioural
Client orientation, tact, discretion and courtesy when dealing with insured persons or medical institutions is indispensable. A high degree of discretion and integrity in dealing with highly sensitive and confidential matters.  Reliability, excellent work relations and a good team spirit are very important.    The ability to work in a multicultural environment and to demonstrate gender-sensitive and non-discriminatory behaviour and attitudes.