Claims Team Leader – Health Insurance

About the role

The Claims Team Leader will head a dedicated claims team, ensuring that all medical claims are processed accurately, in line with scheme rules, clinical protocols, tariffs and fraud‑prevention measures. The role balances operational excellence with cost containment while delivering high‑quality service to clients and members.

Key responsibilities

• Oversee end‑to‑end claims processing, guaranteeing compliance with clinical guidelines, tariffs and policy requirements.
• Monitor and achieve Service Level Agreements (SLAs) with clients, handling escalations and complex or high‑value claims.
• Review and reconcile claims payable reports, support month‑end reconciliation and audit high‑risk claims.
• Identify and report process or system failures, drive continuous improvement initiatives within the team.
• Maintain client relationships, provide expert advice, and produce regular performance reports.
• Foster a positive work environment, lead recruitment, performance management and employee development.

Required profile

• Tertiary qualification in a health‑related field (e.g., Nursing, MBCHB, B.Pharm, B.Cur).
• Registration with the relevant regulatory body for the qualification.
• 4–6 years of experience in claims management.
• 1–2 years of people‑management experience.
• Prior experience in the insurance or related industry.

Required skills

What we offer

• Opportunity to lead a high‑performing claims team within a dynamic health‑insurance environment.
• Professional development and career growth support.
• Collaborative culture focused on service excellence.