Claims Team Leader

About the role

The Claims Team Leader will head the claims department, ensuring that all claims are processed accurately, in line with scheme rules, clinical protocols, tariffs and fraud‑prevention measures. The role balances cost containment with service excellence while supporting the team’s development.

Key responsibilities

• Oversee end‑to‑end claims processing, ensuring compliance with clinical guidelines, tariffs and policy.
• Manage the team’s delivery against Service Level Agreements and monitor turnaround times.
• Act as escalation point for complex, high‑value or high‑risk claims and coordinate fraud investigations.
• Review and reconcile claims payable reports, support month‑end reconciliation and monitor outstanding liabilities.
• Identify process improvements, implement enhancements and report system failures.
• Maintain client relationships, provide regular performance reports and advise on tailored healthcare solutions.
• Foster a positive work climate, coach team members and drive a culture of exceptional client service.

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.
• Experience in the insurance or related industry.

Required skills