ROLE PURPOSE

 

To perform independent quality control of membership onboarding and updates while conducting underwriting assessments where required. The role ensures accurate data capturing, compliant application of Scheme rules and risk protocols, and supports the end-to-end integrity of membership processes through precise quality oversight, risk-based decision-making, and effective stakeholder communication.

 

Key Responsibilities


Quality Control & Underwriting

  • Review onboarding and membership updates for accuracy and rule compliance.
  • Perform underwriting assessments when required and apply risk protocols consistently.
  • Identify recurring quality issues and recommend improvements or training interventions.
  • Document findings and provide coaching feedback to Membership Clerks and Onboarding Specialists.
  • Activate application forms and communicate clear, accurate onboarding outcomes.
  • Resolve membership-related queries with timely updates and accurate information.
  • Clear workflow pending items and ensure timely processing of outstanding cases.
  • Maintain high levels of data integrity and correct identified errors promptly.

Risk, Compliance & Audit Support

  • Apply fraud controls, governance standards and risk-prevention measures.
  • Support internal, external and ISO audits with accurate evidence.
  • Maintain adherence to ISO quality standards across membership processes.
  • Enforce SLAs and support continuous improvement of SOPs and guidelines.
  • Ensure compliance with legislation, Scheme rules and organisational policies.

Stakeholder & Service Engagement

  • Build strong relationships with members, brokers and internal stakeholders.
  • Provide clear communication on onboarding status, requirements and outcomes.
  • Collaborate with cross-functional teams to resolve quality-related challenges.
  • Uphold professional service and contribute to an exceptional onboarding experience.

 

EXPERIENCE

QUALIFICATION

  • 5 years Membership Quality Control 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
  • Business Acumen
  • Annexures and Scheme rules
  • Technical problem solving
  • Medical Insurance Policies
  • Verbal and Written Communication
  • Conflict management
  • Coaching and Mentoring
  • Resilience
  • 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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