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Healthcare Operations Manager

1 week ago

Cape Town, Western Cape, South Africa Momentum Full time
Role Purpose

The Clinical Administrator position is responsible for handling claims clinical responsibilities for GAP Short Term Insurance Products, ensuring that the principles and outcomes of Treating Customers Fairly (TCF) are practiced and achieved.

This role requires a strong background in healthcare and administration, as well as excellent communication and interpersonal skills.

Key Responsibilities

The successful candidate will be responsible for:

  • Handling claims clinical responsibilities for GAP Short Term Insurance Products.
  • Ensuring TCF principles and outcomes are practiced and achieved.
  • Investigating PMB internal claims and negotiating discounts with service providers.
  • Conducting pre-existing claim investigations and recommending outcomes.
  • Resolving client queries and managing expectations.
Requirements

To be successful in this role, you will need to have:

  • A Matric/Grade 12 National Senior Certificate or equivalent.
  • A relevant qualification in a medical or related field, such as nursing or medical technology.
  • Minimum 2-3 years of experience within the life insurance industry in a clinical or claims assessment/administration role.
  • Strong knowledge of medical aid schemes.
  • An understanding of anatomy and physiology.
  • Proficient in Microsoft Office and claims management systems.