ROLE PURPOSE

 

To independently vet, validate and capture new member and dependant applications with full accuracy and compliance, applying Scheme rules, regulatory requirements, and onboarding risk protocols. The role ensures correct documentation, resolves complex onboarding queries, mitigates risk, and enhances the member experience through timely, professional communication.

 

Key Responsibilities


  • Onboarding & Application Assessment
  • Assess, prioritise and process applications based on risk, completeness and urgency.
  • Verify documentation and ensure full compliance with Scheme rules and underwriting requirements.
  • Manage outstanding documentation, clarify requirements and resolve onboarding queries.
  • Maintain accurate audit trails and correct any onboarding errors promptly.
  • Prepare and submit special cases for review and provide clear outcome feedback.
  • Escalate high-risk, non-standard or complex applications appropriately.
  • Stay updated on Scheme rules to support accurate decision-making.

Risk, Compliance & Quality Assurance

  • Apply fraud-prevention practices, governance and risk controls.
  • Support internal, external and ISO audits with accurate documentation.
  • Ensure onboarding processes meet quality and regulatory standards.
  • Identify operational inefficiencies and recommend process improvements.
  • Enforce strict adherence to Scheme rules, policies and SOPs.

Stakeholder Engagement & Service Delivery

  • Liaise directly with brokers, members and internal teams to facilitate seamless onboarding.
  • Provide clear, professional updates on application status and requirements.
  • Resolve onboarding-related queries, complaints and escalations within SLA.
  • Build trust through exceptional customer service and accurate guidance.
  • Support cross-functional collaboration to resolve onboarding issues and protect the Scheme’s reputation.


EXPERIENCE

QUALIFICATION

  • 5 years Membership experience within a Medical Scheme or Administrator
  • Diploma in Healthcare Administration, Risk Management, Quality Management, Business Administration or a related field. (NQF Level 6)

Knowledge

Skills

Attributes

  • Relevant legislation and regulatory frameworks
  • Risk Management practices and principles
  • Annexures and Scheme rules
  • Technical problem solving
  • Medical Insurance Policies
  • Insurance Risk protocols
  • Verbal and Written Communication
  • Negotiation
  • Conflict management
  • Resilience
  • Detail Orientation
  • Innovative Thinking

 

 

 
Register
Back