Consultant– Frauds, State Health Agency, Madhya Pradesh

  • GiZ
  • Job Reference Code: CF-SHA-MP
Last date of application
 02-Sep-21 23:59 HR

 

  

JOB DESCRIPTION

Consultant– Frauds, State Health Agency, Madhya Pradesh

1. POSITIONS VACANT: Consultant– Frauds, State Health Agency, Madhya Pradesh

2. ORGANIZATION BACKGROUND:

The Indo-German Universal Health Coverage Programme (IGUHCP) is part of Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Germany’s enterprise for international cooperation. GIZ works with Indian ministries at the Centre and State Governments for implementation of bilateral cooperation projects.

IGUHC works closely with National Health Authority under Ministry of Health and Family Welfare (MoHFW) and with selected state governments to provide policy advise and implementation support in the areas of Universal Health Coverage, Health Systems Strengthening, Social Health Insurance and health security. Other government ministries/agencies with which IGUHC works closely are NITI Aayog, ESIC, Ministry of Labour and Employment (MoLE), ICMR etc.

In the course of the COVID-19 pandemic, the programme is supporting the Governments at national and State level in implementing additional measures. The objective of these measures is to increase COVID-19 testing and treatment measures across the different regions.

 

Considering the extreme burden on State health system due to COVID and other health services that the health facilities and the workforce is required to perform, it is crucial to frequently analyse the needs and gaps in the health system to maintain delivery of essential health services. Therefore, Department of Health GoUP with support of GIZ-IGUHC would like to establish an IT cell, which can support the Monitoring and Surveillance related activities.

 

As part of this Professional Programme it is proposed to hire a consultant who will support the  SAFU in the State Health Agency for the management of Frauds under PMJAY. The consultant will be expected to support the development of Anti-fraud policies for PM-JAY for the state of Madhya Pradesh. 

 

The objective of the assignment is to support the State Health Agency in implementing Pradhan Mantri – Jan Arogya Yojana (PM-JAY).  Consultant SHAll support the strengthening of existing institutional structures for PM-JAY in the State.
 

3. JOB DESCRIPTION/ RESPONSIBILITIES:

The consultant will be responsible for supporting the State Health Agency with technical inputs on frauds related matters for the implementation of PMJAY. The consultant will work under the direct supervision of the reporting officer assigned by the State Health Agency.


Key Responsibilities:
  
(1) To make himself/herself thoroughly familiar with the AB PM-JAY processes. To acquire an in-depth understanding of the guidelines of the scheme and role of various stakeholders;

(2) Preparation/ updation of various guidelines/ advisories and policy documents under the scheme for fraud control related matters

(3) Ensure smooth communication coordination between different Divisions, Districts and sections of SHA, such as State Coordination, IT, DQAC and Operations, as well as with the districts;

(4) Involve and engage in various committees and sub-committees of SAFU; Support in the development of anti-fraud policies and guidelines (aligned to NHA Anti-Fraud Guidelines) Part 1: National Anti-Fraud Framework, accounting for the implementation specificities of its respective State/UT.

(5) Support in ensuring that all contracts signed by the SHA with any party (Insurer, ISA, TPA, provider, IT agency, etc.) include adequate anti-fraud provisions, safeguards, disincentives and penalties that are enforceable. All references for this should be drawn from model contracts developed by the NHA;

(6) Monitor the prevention of provider empanelment fraud by following laid down guidelines and procedures in transparent and efficient manner;

(7) Support the SHA in ensuring compliance to beneficiary identification/verification guidelines, preauthorization and claims adjudication, audit and payment guidelines. Along with implementation of bio-metric authentication of beneficiary at the time of admission and discharge;

(8) Managing the implementation of system built controls and checks in IT system, and generate real time alerts to stakeholders. Supporting in the limited/restrict the use of ‘unspecified’ packages;

(9) Undertake any other assignment/ responsibility given by SHA. Support in building anti-fraud awareness, public messaging.  

 

4. QUALIFICATION, SKILLS AND EXPERIENCE: 
     

Qualifications:
Graduation or higher qualification in MBBS, BDS, BHMS, BAMS from a recognized university or institute.


Experience:

(1) 5-6 years of relevant post qualification professional experience in working for health insurance scheme or private health insurance companies;

(2) Proven fraud management skills  while working with government health insurance schemes or private insurance companies;

(3) Experience in the development sector and prior experience of working with government and development partners

(4) Experience in overseeing public health, rural development or social welfare projects SHAll be preferred;

(5) Demonstrated experience in operationalizing health program at field level/ working in strengthening of district level health systems.

 

Skills and Competencies:

(1) Experience of working in E-Office and managing file notings and drafting, for government documentations;

(2) Strong verbal and written communication and presentation skills;

(3) Computer literate with knowledge and experience of MS Office, Excel and PowerPoint;

(4) Proficient in drafting notes and letters in English and Hindi, with emphasis on spelling, punctuation, grammar and other language skills;

(5) Language skills in English and Hindi.

5. VACANCY DETAILS: One vacancy

6. COMPENSATION OFFERED:

The offer made to the selected candidate shall be commensurate with qualifications, experience, and salary history.

 

7. NATURE OF ENGAGEMENT:

 

The Consultant shall be hired on a consultancy contract through Strategic Alliance Management Services P Ltd. (SAMS), a respected HR Agency.

 

8. LOCATION: The Consultant will be placed in State Heath Agency of Madhya Pradesh.


9. CONTRACT TYPE AND PERIOD:
The post-holder shall be engaged on a consultancy contract, initially for a period of one year, extendable thereafter, on the basis of performance and approval by SHA.

10. REFERENCE: CF-SHA-MP


11. CONTACT INFORMATION:
Team SAMS
Strategic Alliance Management Services P Ltd.
1/1B, Choudhary Hetram House, Bharat Nagar
New Friends Colony, New Delhi 110 025
Phone Nos.: 011-41011564/65; 4081 9900

12. LAST DATE FOR APPLICATIONS:

Eligible candidates interested in the position are requested to apply using the link https://recruitment.samshrm.com/Jobs/GIZ by or before September 2, 2021.