Job Description

Closing Date 2025/12/02
Reference Number MMH251121-19
Job Title Team Leader: Specialised Admin
Position Type Permanent
Role Family Client Services
Cluster Momentum Health
Remote Opportunity None of the time
Location - Country South Africa
Location - Province Eastern Cape
Location - Town / City Gqeberha
Introduction
Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.
Disclaimer As an applicant, please verify the legitimacy of this job advert on our company career page.
Role Purpose
To lead and oversee specialised medical scheme claims administration and compliance processes, ensuring accurate system setup, adherence to governance and quality standards and driving team performance to deliver efficient, client-focused service.
Requirements

• A National Senior / Matric Certificate is essential
• Relevant tertiary qualification in administration and/or business processes, including but not limited to Degree/Diploma in Business/Office Administration or Business/Office Management etc.
• 3 - 5 Years' working experience in a medical scheme claims or administration environment is essential
• Minimum of two years' experience leading a team is preferred
• Extensive knowledge of the medical scheme administration industry, including:

• Specialised claims processes (Ex gratia claims, motor vehicle accident claims, prescribed minimum benefit claims)
• Claims Payment Process
• Knowledge of Medical Scheme Governance
• Exposure to quality management principles through a structured quality management system

Duties & Responsibilities
Client Service and Administration

• Oversee the processing of specialised claims, including motor vehicle accident claims, prescribed minimum benefit claims, Ex gratia claims and the claims payment process.
• Oversee the loading of all benefit changes onto the system and ensure accurate claim processing through testing.
• Supervise year-end tariff loading and validate correct claim processing.
• Resolve escalated queries related to specialised claims.
• Monitor and report on compliance with Service Level Agreements (SLAs).
• Coordinate special projects involving system setup for claims processing (including benefit loading and testing).
• Identify and implement opportunities for process improvement, automation and cost efficiency.

Compliance

• Ensure strict adherence to scheme Service Level Agreements.
• Maintain compliance with all applicable legislation.
• Understand and enforce quality management system requirements within the team.
• Identify, report and address risks and opportunities through the quality management system.

People Management

• Lead and develop the team to achieve high performance and engagement.
• Set clear objectives, conduct regular performance reviews and provide constructive feedback.
• Foster a positive work environment that promotes accountability, motivation and well-being.
• Monitor and report on team performance against targets.

Competencies

• Directing people
• Understanding people
• Establishing report
• Showing composure
• Team working
• Making decisions
• Resolving conflict
• Communication skills (written and verbal)
• Analytical skills
• Planning skills
• Interpersonal skills
• Attention to detail

Policy
We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

Skills Required