Our client, based in Johannesburg is seeking to employ a Claims Team Leader to join their team within the medical aid industry.

The successful candidate will be responsible for leading, managing and supporting the claims team to ensure the accurate and efficient processing of medical claims and resolution of client queries. The role focuses on maintaining service excellence, achieving operational targets, improving claims administration processes and ensuring compliance with service level agreements and industry standards.

Requirements:

• National Senior Certificate / Matric
• 4 – 6 Years’ experience in Medical Claims Management
• 1 – 2 Years’ people management experience
• Medical aid industry experience essential
• Strong leadership and team management ability
• Excellent customer service and stakeholder management skills
• Strong analytical and problem-solving skills
• Ability to work under pressure and meet deadlines
• Excellent communication skills both written and verbal
• Strong organisational and administrative skills
• High attention to detail and accuracy
• Professional, resilient and results driven
• Computer literacy and claims systems experience

Responsibilities:

• Oversee the accurate and efficient processing of medical claims and related client queries.
• Ensure claims are processed within agreed turnaround times and quality standards.
• Act as the escalation point for complex claims and unresolved client queries.
• Monitor workflow distribution and ensure productivity targets are achieved.
• Ensure adherence to claims administration procedures and company policies.
• Identify operational inefficiencies and implement process improvements.
• Investigate and resolve escalated claims issues within agreed timelines.
• Monitor service delivery standards and drive continuous improvement initiatives.
• Provide professional, accurate and timeous feedback to clients and stakeholders.
• Build and maintain strong relationships with clients, healthcare providers and internal stakeholders.
• Ensure exceptional client service and customer satisfaction at all times.
• Handle escalated complaints and ensure appropriate resolution.
• Provide regular reporting on claims performance and service delivery metrics.
• Support initiatives that improve client experience and fair treatment of customers.
• Lead, coach, mentor and develop Claims Administrators and support staff.
• Conduct regular performance management discussions and performance reviews.
• Monitor attendance, productivity and service delivery standards within the team.
• Support staff training, development and succession planning initiatives.
• Promote teamwork, collaboration and a positive working environment.
• Drive accountability and a high-performance culture within the department.
• Ensure compliance with company policies, healthcare industry regulations and operational procedures.
• Identify and escalate operational risks and process failures.
• Support audit requirements and maintain accurate claims records.
• Monitor adherence to quality assurance and compliance standards.
• Recommend process enhancements to improve operational efficiency and client experience.
• Prepare and submit operational and performance reports.
• Monitor claims trends, service levels and query resolution statistics.
• Maintain accurate documentation and claims records.
• Ensure all reporting deadlines are met accurately and timeously

Only shortlisted candidates will be contacted. If you do not receive feedback within two weeks of applying, please consider your application unsuccessful.