1 Claims process owner Jobs and Work in Gauteng Gauteng

Claims Process Owner
PPO Serve —Alberton, Gauteng
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Claims Process Owner
PPO Serve —Alberton, Gauteng
While core processes are largely automated (or being automated), this role ensures data integrity, process efficiency, stakeholder alignment and timely,…
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Claims Process Owner

PPO Serve
Alberton, Gauteng

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Job Details

Temp to perm

Full Job Description

The Claims Process Owner is responsible for the end-to-end ownership, governance and optimisation of PPO Serve’s monthly claims process. While core processes are largely automated (or being automated), this role ensures data integrity, process efficiency, stakeholder alignment and timely, accurate claims delivery. The Claims Process Owner acts as the central point of coordination between PPO analytics, finance, operations and external stakeholders (actuaries and other service providers).

End- to End Claims Process Ownership

Own the full monthly claims cycle from data receipt to payments to doctors
Oversee and audit automated pipelines for claims generation and validation
Ensure adherence to documented methodologies for claims inclusion and payment models
Manage timelines, dependencies and critical deadlines

Data Governance & Quality Control

Oversee provider file management in collaboration with PPO Sales
Validate outputs from internal and external membership files
Perform quality control checks on membership files throughout the claims cycle
Investigate and resolve data discrepancies at line level where required
Prepare month-end reconciliation report

Automation & Continuous Improvement

Support migration and optimisation of claims processes within PPO Serve’s data platform
Identify process risks, inefficiencies and control gaps
Maintain clear process documentation and audit trails

Stakeholder Engagement & Issue Resolution

Primary point of contact for all claim-related queries – internal (doctors, coaches, finance) and external (actuaries, medical schemes)
Proactive communication regarding risks, delays or discrepancies

Skills & Compentencies

Strong process management and governance capability
High attention to detail and data integrity
Analytical problem-solving ability
Stakeholder management and communication skills
Ability to operate within automated data environments

Technical Requirements

Advanced Excel
Working knowledge of Power BI
Experience managing data pipelines and structured data exchanges is advantageous

Qualifications & Experience

Business-related degree or equivalent
Minimum 5 years’ experience in Bookkeeping, Business Analyst, Claims, or Scheme-related role
Experience within a medical scheme or healthcare funding environment preferred

WHAT WE OFFER

Opportunity to make a significant impact on real-world healthcare challenges.
Be part of a collaborative, innovative, and data-driven culture.
Competitive market-related salary.
Opportunities for professional growth and continuous learning with cutting-edge technologies.
A commitment to work-life balance and a supportive team environment.

* IF WE HAVE NOT CONTACTED YOU 14 DAYS PLEASE CONSIDER YOUR APPLICATION UNSUCCESSFUL*

Work Location: Hybrid remote in Alberton, Gauteng

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