ROLE PURPOSE

 

Accountable for operational oversight and manage the development and implementation of tactical work plans as well as formulate associated procedures to ensure the effective operational implementation of key support services within the Operational Service Centre function. To support the Scheme’s value chain and strategic initiatives of excellent customer service.

 

Key Responsibilities


Tactical Leadership & Customer Experience

  • Translate the customer satisfaction strategy into executable plans.
  • Build a strong customer-centric culture aligned to the Customer Care Charter.
  • Drive service improvements, digital self-help innovations and first-contact resolution.
  • Reduce unnecessary customer contacts through improved processes, education and proactive communication.
  • Champion TCF (Treating Customers Fairly) and consistent service transparency.

Operational Excellence (Multi-Sub-Division Oversight)

  • Manage day-to-day operations across Support Services, Contact Centre, Specialised Assessors, Claims Assessors and Complaints.
  • Ensure SLA adherence, data integrity, quality assurance and continuous process optimisation.
  • Drive end-to-end process enhancements, system improvements and operational innovation.
  • Oversee query management, complaint resolution, root-cause analysis and corrective action.
  • Lead reporting, dashboards, and operational insights to support decision-making.
  • May be required to travel for business requirements.


Project & Change Delivery

  • Lead operational rollout of new and enhanced service initiatives.
  • Support system development, testing, annexure verification and year-end processes.
  • Ensure effective implementation support for special projects and campaigns.

Risk, Compliance & Quality

  • Enforce governance, fraud controls, compliance standards and ISO-aligned quality frameworks.
  • Maintain and enforce divisional SLAs.
  • Ensure adherence to legislation, internal controls, policies and risk prevention measures.
  • Support internal and external audit requirements.

People Leadership

  • Lead, mentor and grow a high-performance, customer-focused team.
  • Drive talent development, succession planning and retention strategies.
  • Manage performance, productivity and engagement across the sub-divisions.

Stakeholder Engagement

  • Strengthen relationships with internal and external stakeholders.
  • Remove operational barriers to service delivery.
  • Represent the Service Excellence unit in committees, task teams and industry forums.
  • Communicate progress, risks and achievements timeously to key stakeholders.


EXPERIENCE

QUALIFICATION

  • Minimum 5 years working experience in a medical Scheme/Medical Administrator
  • Technical knowledge 5 years of NEXUS system experience
  • 5+ years in Managing Customer Service and/or Contact Centre and/or Claims processing and/or  Quality Management Systems processing/auditing

 

  • Diploma in Business Management /Administration (NQF Level 6)
  • Degree in Business Administration (NQF Level 7)

Knowledge

Skills

Attributes

  • Relevant legislation and regulatory frameworks
  • Risk Management practices and principles
  • Business Acumen
  • Financial budgeting and management processes
  • Medical Insurance Policies
  • Insurance Risk protocols
  • Technical problem solving
  • Annexures and Scheme rules
  • Service Level Agreements
  • Verbal and Written Communication
  • Presentations
  • Project Management
  • Coaching and Mentoring
  • Conflict management
  • Computer literacy
  • Claims processes
  • Resilience
  • Strategic Thinking
  • Detail Orientation
  • Innovative Thinking
  • Customer Centric
  • Results Focused
  • Quality Focused
  • Assertiveness
  • Compliance Driven
  • Emotional Maturity
  • Analytical Thinking
  • Problem Solving
  • Logical Reasoning
  • Judgement and Decision-making

 

 

 
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