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 essential...

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: 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...

Minimum Requirements - Matric. - RE5 qualification. - Degree in Law, Risk Management, Insurance, Commerce, or a related field. - Class of Business certification (advantageous). - FAIS Fit and Proper compliant. - 510 years' experience in short-term insurance claims. - Proven experience handling large losses and complex commercial claims. - Experience...

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...

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...

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. Experience: 8 years Managed Care experience preferred Qualifications: MBChB Position Specific Outputs and generic objectives: Assess and provide clinical...

Healthcare Consultant - Cape Town Do you have experience working in the BPO industry? Ready for the next step in your career? Read on! The role of the healthcare consultant is to manage and service and retain a portfolio of clients by applying company policies and procedures to deliver varied technical and professional activities. The healthcare consultant...

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.Experience: 8 years Managed Care experience preferredQualifications: MBChBPosition Specific Outputs and generic objectives:Assess and provide clinical recommendations on...

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...

Introduction BA Personnel is a trusted Executive Principal Talent Specialist Company with a proven track record in identifying, attracting, and securing exceptional talent for niche, specialist, and leadership appointments across South Africa and international markets. Leveraging deep industry expertise, extensive executive networks, and a consultative...

Stay safe online. Now more than ever it’s important to be cybersafe. See Santam’s tips to help you stay safe online. Learn more. 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...

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...

Duties & Responsibilities Main Job Responsibilities: Daily Ensure accurate processing and verification of supplier invoices by the validations team Ensure all Excess Waiver validations are done daily by close of business Import all validated invoices into Evolution by 08h30 daily. Manage the scheduling and execution of payments in line with agreed payment...

Posting Description Healthcare Consultant Do you have experience working in the BPO industry? Ready for the next step in your career? Read on! The role of the healthcare consultant is to manage and service and retain a portfolio of clients by applying company policies and procedures to deliver varied technical and professional activities. The healthcare...

Healthcare Consultant Do you have experience working in the BPO industry? Ready for the next step in your career? Read on! The role of the healthcare consultant is to manage and service and retain a portfolio of clients by applying company policies and procedures to deliver varied technical and professional activities. The healthcare consultant is the...

Position Purpose To provide an intermediate support level between case managers and the medical advisor in the Oncology Medical Advisors Team. 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. Qualifications Bachelor of Pharmacy...

Introduction BA Personnel is a trusted Executive Principal Talent Specialist Company with a proven track record in identifying, attracting, and securing exceptional talent for niche, specialist, and leadership appointments across South Africa and international markets. Leveraging deep industry expertise, extensive executive networks, and a consultative...