Senior International Consultant – Health Financing Information Systems and Provider Payment Analytics

The consultant will provide senior international technical expertise to strengthen the strategic use of information for health financing and purchasing reforms in Ukraine. The role involves advising on health financing information systems, claims analytics, provider payment methodologies, and decision-support tools underpinning the Program of Medical Guarantees, including technical guidance, capacity building, and methodological leadership.

Responsibilities

• Review Ukraine’s health financing information systems, claims management arrangements, provider payment methods, tariff methodologies and coding practices, drawing on relevant international experience.
• Develop or refine analytical methodologies, payment algorithms, case-grouping approaches, costing and tariff-setting frameworks, payment simulations and provider performance indicators.
• Analyse administrative and claims data to identify utilization patterns, provider behaviour, coding practices, expenditure trends, case-mix variation and potential anomalies.
• Translate provider payment methodologies into functional and technical requirements for implementation through the eHealth system and related information systems.
• Provide methodological guidance, peer review and quality assurance for WHO analytical work.
• Support technical consultations, capacity building and preparation of methodological guidance, reports and technical materials.
• Assess health financing information and claims-management arrangements supporting purchasing and provider payment under the Program of Medical Guarantees.
• Advise on information architecture, minimum datasets, classifications, coding requirements and data-quality controls required for strategic purchasing.
• Develop or refine methods for analysing claims data, including service utilization, case mix, provider performance, coding quality, expenditure patterns and payment incentives.
• Provide technical guidance on claims submission, validation, adjudication, audit, outlier management and inappropriate coding or billing.
• Support design and refinement of provider payment methodologies, including DRGs and other case-mix approaches, case-based payment, capitation, bundled payment and blended models.
• Develop or review approaches to patient classification, relative weights, base rates, adjustment coefficients, outlier payments, costing and tariff setting.
• Conduct or support payment simulations and budget-impact analyses of proposed payment reforms.
• Translate agreed payment methodologies into algorithms, business rules and technical specifications for electronic implementation.
• Develop indicators for monitoring provider behaviour, coding quality, payment distribution, efficiency and equity.
• Provide senior peer review, methodological guidance and capacity building to WHO analysts and national counterparts.
• Prepare technical reports summarizing findings, methodological decisions and recommendations.

Requirements

• Advanced university degree at Master’s level or higher in health economics, economics, statistics, actuarial science, health informatics, public health, health policy, health financing, information systems or another relevant field.
• At least 10 years of international professional experience as a health financing specialist designing information solutions for health financing and purchasing and analysing resulting data patterns.
• Demonstrated experience strengthening health financing arrangements through the more strategic use of information at country level.
• Demonstrated experience advising governments, public purchasers, national health insurance agencies or similar institutions on health financing or strategic purchasing reforms.
• Extensive experience working with administrative claims, reimbursement or provider payment data.
• Demonstrated experience in the design, implementation or evaluation of provider payment systems.
• Experience translating health financing policy and payment methodologies into information-system requirements, algorithms or business rules.
• Experience preparing high-quality technical reports, methodological guidance and policy recommendations for governments or international organizations.
• Experience with diagnosis-related groups or other case-mix-based hospital payment systems (desirable).
• Experience with capitation, bundled payment, prospective payment or blended provider payment systems (desirable).
• Experience in claims management, claims adjudication, coding quality, fraud or anomaly detection, and provider audit systems (desirable).
• Experience working with WHO, the World Bank, the European Union or other international organizations and development partners (desirable).
• Experience working with ministries of health, national health purchasers or social health insurance organizations in multiple countries (desirable).
• Experience developing or applying costing, tariff-setting, payment-modelling or budget-impact methodologies (desirable).
• Expert knowledge of strategic purchasing, provider payment systems and health financing information systems.
• Strong understanding of claims management, case-mix classification, DRGs and prospective payment.
• Strong knowledge of costing, tariff setting, relative weights, base-rate calculation and payment simulation.
• Ability to analyse complex administrative datasets and translate findings into practical policy and system recommendations.
• Ability to develop functional requirements, payment algorithms and business rules for digital systems.
• Excellent analytical, technical writing, presentation and stakeholder-engagement skills.
• Knowledge of coding systems and classifications relevant to provider payment, such as ICD, procedure classifications and DRG groupers (desirable).
• Familiarity with SQL, R, Python, Stata, SAS or other tools used to analyse large claims datasets (desirable).
• Experience with business-intelligence and visualization platforms such as Power BI or Tableau (desirable).
• Knowledge of data governance, interoperability and health information-system architecture (desirable).
• Expert knowledge of English.

Skills

• Health Economics
• Health Financing
• Health Informatics
• Health Policy
• Health Financing Information Systems
• Provider Payment Systems
• Strategic Sourcing
• Claims Management
• Case-Mix Classification
• Diagnosis-Related Groups
• Capitation Payment Systems
• Bundled Payment Systems
• Prospective Payment Systems
• Claims Adjudication
• Coding Quality
• Fraud Detection
• Provider Audit Systems
• Costing Methodologies
• Tariff Setting
• Payment Modelling
• Financial Impact Analysis
• Data Analysis
• Payment Algorithms
• Business Rules
• Technical Report Preparation
• Policy Recommendations
• Stakeholder Engagement
• SQL
• Python
• STATA
• SAS
• Power BI
• Tableau
• Data Governance
• Health Information System Architecture
• Interoperability

Languages

English