Claims Team Leader - Gauteng

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

• 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