Team Leader: Specialised Admin MMH

Role Purpose

To lead and oversee specialised medical scheme claims administration and compliance processes, ensuring accurate system setup, adherence to governance and quality standards and driving team performance to deliver efficient, client-focused service.

• A National Senior / Matric Certificate is essential
• Relevant tertiary qualification in administration and/or business processes, including but not limited to Degree/Diploma in Business/Office Administration or Business/Office Management etc.
• 3 - 5 Years' working experience in a medical scheme claims or administration environment is essential
• Minimum of two years’ experience leading a team is preferred
• Extensive knowledge of the medical scheme administration industry, including:
  • Specialised claims processes (Ex gratia claims, motor vehicle accident claims, prescribed minimum benefit claims)
  • Claims Payment Process
• Knowledge of Medical Scheme Governance
• Exposure to quality management principles through a structured quality management system

• Oversee the processing of specialised claims, including motor vehicle accident claims, prescribed minimum benefit claims, Ex gratia claims and the claims payment process.
• Oversee the loading of all benefit changes onto the system and ensure accurate claim processing through testing.
• Supervise year-end tariff loading and validate correct claim processing.
• Resolve escalated queries related to specialised claims.
• Monitor and report on compliance with Service Level Agreements (SLAs).
• Coordinate special projects involving system setup for claims processing буде (including benefit loading and testing).
• Identify and implement opportunities for process improvement, automation and cost efficiency.

• Ensure strict adherence to scheme Service Level Agreements.
• Maintain compliance with all applicable legislation.
• Understand and enforce quality management system requirements within the team.
• Identify, report and address risks and opportunities through the quality management system.

• Lead and develop the team to achieve high performance and engagement.
• Set clear objectives, conduct regular performance reviews and provide constructive feedback.
• Foster a positive work environment that promotes irradione accountability, motivation and well-being.
• Monitor and report on team performance against targets.