Specialist Risk Equalization

Job Description

The The job holder shall be responsible for ensuring that no risk rating or risk selection is practiced by Private Health Insurers (PHI), the core task of the Risk Equalization Specialist will be a diverse portfolio of responsibilities, all related to the key objective of ensuring that the SHIS performs effectively and efficiently and that HFID is taking appropriate, optimized regulatory interventions.

1. Oversee the design and implementation of sound risk equalization mechanism, design risk equalization processes and procedures across the SHIS to maximize process efficiency and premium optimisation.
2. Oversee the implementation of policies necessary for setting the health insurance premiums through actuarial analysis.
3. Ensure that no risk selection is practiced by PHIs.
4. Develop specific ongoing and one-time data requirements needed to perform analyses to support risk equalization mechanism development.
5. Participate in the development of proposed policy relating to and across the SHIS, based on the robust analysis of qualitative and quantitative evidence. When appropriate, this will also involve drawing on international best practice.
6. Conduct both planned and ad-hoc research into performance or regulatory issues arising from regular analysis of quantitative and qualitative system information, to support policy or regulatory development.
7. Support in the evaluation of both quantitative and qualitative performance information gathered by the SHIS.
8. Assist the Head of Finance and Actuary in reviewing priorities, and spending against those priorities.
9. Lead the development of and assess the risk rating and risk selection for underwriting.
10. Ensure high-risk persons (elderly, disabled and different population categories entitled to government subsidy as specified by the SHIS Law and its Implementing Regulation) pay their premium partly with government subsidy and partly by their employer or sponsor. The subsidies may be earmarked for the purchase of specified insurance coverage.
11. Support in drafting of the annual financial report of the SHIS Scheme.
12. Lead the scoping, development and drafting of major qualitative and quantitative research programmers.
13. Prepare and present report when required for the HFID.
14. Understand equivalence principle and premium adjustments as per the risk profile, risk rated premiums across groups and sub-groups, premium subsidization rate variation and risk subset factors, Diagnosis based risk adjustments, with alignment of weights with normative cos and health status measurements scales and validity testing.
15. Manage and overlook Risk Equalization Fund.
16. Ensure the risk adjusted subsidizes are aligned with the policy goals.
17. Implement monitoring and evaluation tools to ensure the effectiveness of risk adjusted premium subsidies.
18. Present regulation and policies to and for improving the subsidies with profit /loss predictability.
19. To work closely with other members of the senior management team to ensure a consistent approach to regulation.
20. Maintain relationships with regulated bodies or prospective regulated bodies, and to be a representative of the NHIS at public events, conferences and seminars; and
21. Maintain relationships with senior members of other regulatory agencies across the country.
22. Perform other duties as requested to meet the ongoing organizational needs.

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