ROLE PURPOSE

 

To monitor and evaluate agents daily across divisions, ensuring processes are followed according to Standard Operating Procedures. The role focuses on identifying process gaps, improving efficiencies, and ensuring alignment between Quality Assurance practices and the broader Operations division.

 

Key Responsibilities


Functional Management


  • Conduct quality assurance assessments in line with standards and SOPs.
  • Resolve stakeholder queries and disputes fairly in line with Scheme rules and protocols.
  • Perform root cause analysis, live monitoring and calibrations.
  • Identify process gaps across business areas and recommend improvements.
  • Participate in operational immersion activities (calls, emails, WhatsApp, face-to-face etc).
  • Compile quality control reports, discrepancy reports, and recommend improvements.
  • Provide structured feedback and coaching to agents based on QA outcomes.
  • Submit monthly quality summaries and feedback to relevant business areas.
  • Identify training needs and collaborate with Learning & Development.
  • Participate in the development and negotiation of in-house quality procedures.
  • Conduct regular compliance audits relating to quality standards.
  • Support quality assurance-related projects, campaigns and initiatives.
  • Perform cross-functional duties/rotations as required.

Risk & Compliance


  • Adhere to fraud controls, risk prevention principles, governance and compliance processes.
  • Support and provide evidence for internal, external and ISO audits.
  • Maintain quality risk management standards aligned to ISO9001:2015.
  • Enforce quality-related SLAs to reduce business risk.
  • Review SOPs with QA leadership to support business optimisation.
  • Adhere to all relevant laws, policies and Standard Operating Procedures.

Stakeholder Management


  • Build and maintain strong internal and external stakeholder relationships.
  • Conduct coaching sessions, training and workshops on identified non-conformities.
  • Support business units in achieving organisational goals.


EXPERIENCE

QUALIFICATION

  • 2 Years in Quality Assurance or Team leader role (advantage)
  • Minimum 5 Years in working in the Medical Scheme/Medical Administrator scheme
  • Strong knowledge and hand-on experience on scheme operations  including Claims processing/Membership/Credit control/PMB, Contact centre operations
  • 5 Years’ Experience in Customer Service
  • Technical knowledge 5 years of NEXUS system experience(preferred)

 

  • Grade 12 / Matric/ NQF Level 4

Knowledge

Skills

Attributes

  • Relevant legislation and regulatory frameworks
  • Quality Assurance Management practices and principles
  • Business Acumen
  • Quality Control principles
  • Verbal and Written Communication
  • Coaching and Mentoring
  • Conflict Management
  • Presentations
  • Resilience
  • Detail Orientation
  • Innovative Thinking
  • Customer Centric
  • Results Focused
  • Quality Focused
  • Compliance Driven
  • Innovative thinking
  • Analytical Thinking
  • Problem Solving
  • Judgement and Decision-Making
  • Adaptable and Flexible

 

 

 
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