gratiae

Private Health Administrators (Pty) Ltd is seeking a clinical assessor to provide expert evaluation and decision support for ex gratia applications, CMS complaints, appeals and disputes. You will review clinical documentation, apply PMB regulations, and ensure compliant, well-motivated decisions.Responsibilities include managing CMS escalations, drafting...

Private Health Administrators (Pty) Ltd in Centurion seeks an experienced clinician to provide expert assessment and decision support for ex-gratia applications, CMS complaints, appeals and disputes. You will evaluate clinical data, PMB compliance and prepare structured summaries for committees. Collaborative engagement with providers and members is...

Private Health Administrators (Pty) Ltd is seeking a clinical assessor to provide expert evaluation and decision support for ex gratia applications, CMS complaints, appeals and disputes. You will review clinical documentation, apply PMB regulations, and ensure compliant, well-motivated decisions. Responsibilities include managing CMS escalations, drafting...

Private Health Administrators (Pty) Ltd in Centurion seeks an experienced clinician to provide expert assessment and decision support for ex-gratia applications, CMS complaints, appeals and disputes. You will evaluate clinical data, PMB compliance and prepare structured summaries for committees.Collaborative engagement with providers and members is essential...

Position Purpose: The Senior Risk Manager is responsible for providing strategic leadership, governance and oversight of the Medical Advisory Unit’s clinical risk portfolio, with specific accountability for the Appeals and Disputes Team, including Appeals, Disputes, Council for Medical Schemes (CMS) complaints, Ex-gratia funding requests and regulatory...

Position Purpose: To provide expert clinical assessment and decision making in relation to Ex gratia applications, regulatory (CMS) complaints, appeals, disputes and escalations. Experience: 2-5 years relevant managed care, health risk and clinical customer service within Medical Scheme Administration industry or similar. Solid working experience with...

Position Purpose: To provide expert clinical assessment and decision making in relation to Ex gratia applications, regulatory (CMS) complaints, appeals, disputes and escalations. Experience: 5 years relevant managed care, health risk and clinical customer service within Medical Scheme Administration industry or similar. Solid working experience with the...

Position Purpose: To provide expert clinical assessment and decision making in relation to Ex gratia applications, regulatory (CMS) complaints, appeals, disputes and escalations. Experience: 5 years relevant managed care, health risk and clinical customer service within Medical Scheme Administration industry or similar. Solid working experience with the...

Position Purpose: To provide expert clinical assessment and decision making in relation to Ex gratia applications, regulatory (CMS) complaints, appeals, disputes and escalations. Experience: 2-5 years relevant managed care, health risk and clinical customer service within Medical Scheme Administration industry or similar. Solid working experience with the...

Position Purpose: The Senior Risk Manager is responsible for providing strategic leadership, governance and oversight of the Medical Advisory Unit’s clinical risk portfolio, with specific accountability for the Appeals and Disputes Team, including Appeals, Disputes, Council for Medical Schemes (CMS) complaints, Ex-gratia funding requests and regulatory...

Position Purpose To ensure that the scheme or organisation is protected from over-utilisation or inappropriate claiming by service providers that leads to abuse of member and scheme funds. Duties & Responsibilities Key responsibilities: Provide clinical inputs on ex‑gratia funding requests - Open, review and resolve all clinical queries and assessments...

CLIENT A top medical aid administrator with a strong managed care program for Optometry and Renal Dialysis (amongst other disease areas) is seeking candidates who either have strong OPTOMETRY or RENAL DIALYSIS subject matter expertise (two positions) coupled with strong benefits design optimization, risk management, contracting management, and regulatory...

CLIENT A top medical aid administrator with a strong managed care program for Optometry and Renal Dialysis (amongst other disease areas) is seeking candidates who either have strong OPTOMETRY or RENAL DIALYSIS subject matter expertise (two positions) coupled with strong benefits design optimization, risk management, contracting management, and regulatory...

Senior Manager: IL Claims Administration_Long Term Insurance Sector: Insurance Location: Pretoria Salary: R900 000 (negotiable) Our client in the insurance sector is looking for a Claims Administrator to monitor the management of individual life claims administration. Responsibilities Monitor management of claims administration on individual life...

What will you do? Position Purpose To ensure that the scheme or organisation is protected from over-utilisation or inappropriate claiming by service providers that leads to abuse of member and scheme funds. Key responsibilities: • Provide clinical inputs on ex-gratia funding requests - Open, review and resolve all clinical queries and assessments through...

Our client in the Insurance industry is seeking a Manager: IL Client Servicing Call Centre to join their team. A rewarding and challenging career opportunity for an individual with proven supervisory and problem solving skills exists in the Call Centre Department and we are inviting applicants from suitably qualified persons to apply. Should you meet the...

ABOUT THE ROLE Assume the overall responsibility for growth and profitability of Crop Insurance in the designated area, keeping and expanding contact with the clients, in line with Santam and Broker objectives. Provide technical support and assessments and deliver a high-quality service and support to the client base. RESPONSIBILITIES Portfolio...

About Discovery Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global...

Job Location: Bloemfontein, Free State, South Africa ABOUT THE ROLE Assume the overall responsibility for growth and profitability of Crop Insurance in the designated area, keeping and expanding contact with the clients, in line with Santam and Broker objectives. Provide technical support and assessments and deliver a high-quality service and support to the...

About Discovery Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global...