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

Provides senior technical leadership for Ukraine’s health-financing information systems and provider-payment reforms. The consultant analyses claims and payment data, refines costing, tariff and case-mix methods, translates policy into digital-system requirements, and supports national counterparts with rigorous analytics, peer review and practical decision-support tools for strategic purchasing.

• Assess health-financing information architecture and claims-management arrangements
• Develop methods for claims analysis, provider performance, coding quality and payment incentives
• Advise on case-based, capitation, bundled and blended provider-payment methods
• Develop case-mix, tariff-setting, relative-weight and payment-simulation approaches
• Translate payment methods into algorithms, business rules and system requirements
• Develop indicators for payment distribution, efficiency, equity and provider behaviour
• Provide peer review, methodological guidance and capacity building to analysts and counterparts
• Prepare technical reports and recommendations for financing reforms

• Advanced degree in Health Economics, Economics, Statistics, Actuarial Science, Health Informatics, Public Health, Health Policy, Health Financing, Information Systems or a related field
• At least 10 years of international experience in health financing, purchasing information solutions and data analysis
• Experience advising governments, public purchasers or health-insurance agencies on financing reforms
• Extensive experience with administrative claims, reimbursement or provider-payment data
• Expert knowledge of English

• Experience with diagnosis-related groups or case-mix hospital payment systems
• Experience with capitation, bundled, prospective or blended payment systems
• Claims adjudication, coding-quality, fraud-detection or provider-audit experience
• Experience with WHO, the World Bank, the European Union or other development partners
• Experience with data interoperability and health-information-system architecture

• Strategic Purchasing
• Provider Payment Systems
• Claims Analytics
• Health Financing Information Systems
• Case-Mix Analysis
• Costing
• Tariff Setting
• Payment Simulation
• Data Governance
• Technical Specification Development
• Capacity Building

• SQL
• R
• Python
• Stata
• SAS
• Power BI
• Tableau
• ICD

• Primarily remote, desk-based consultancy with one or two possible security-cleared missions to Ukraine
• Part-time external consultancy for six months