Service Manager - Claims Management

Job Advert Summary

We are recruiting for a hands-on leader to manage the day-to-day planning, operations and performance of a claims team to ensure adherence to service level agreements, operational efficiency, and consistent delivery of a superior customer experience.

Minimum Requirements

Grade 12 (essential)

Relevant tertiary qualification (desirable)

Minimum 4+ years medical scheme administration experience

Minimum 2+ years people management or supervisory experience

Understanding of policies, procedures and SLA frameworks

Knowledge of PMB legislation and regulatory requirements

Planning and organisational skills

Strong communication and interpersonal skills

Problem solving and decision-making ability

Performance management and team leadership capability

Reporting and data analysis skills

Computer literacy and operational systems knowledge

Quality and customer service orientation

Duties and Responsibilities

1. Manage daily claims operations, including workflow allocation, queue monitoring and SLA adherence

• Monitor daily workflow queues and task allocation
• Track SLA adherence (TAT, volumes, backlog) daily
• Ensure consultants follow processes and work instructions
• Intervene in immediate operational blockages (system, workload imbalances)
• Manage attendance and productivity

2. Monitor team performance, productivity and quality, ensuring targets and turnaround times are achieved

• Monitor SLA performance daily and take corrective action
• Ensure team meets agreed targets (quality, turnaround times)
• Escalate risks or consistent underperformance
• Conduct team-level performance tracking

3. Resolve operational issues, customer escalations and service delivery disruptions

• Communicate operational updates within team
• Liaise with internal departments for query resolution
• Resolve escalated customer queries and complaints
• Address immediate service failures
• Ensure effective internal communication flow

4. Ensure compliance with policies, procedures, legislation and internal process requirements

• Ensure adherence to policies, procedures, and SLAs
• Address audit queries at operational level
• Escalate compliance risks

5. Support and implement process improvements to enhance operational efficiency

• Identify inefficiencies in daily operations
• Suggest practical process improvements
• Implement operational changes within the team
• Update work instructions and procedures

6. Compile, analyse and report on operational performance, trends and risks

• Compile daily/weekly performance reports
• Track team metrics (productivity, quality, SLA adherence)
• Provide basic analysis of performance issues

7. Manage staff planning to include scheduling, leave management and resource allocation

• Manage day-to-day team performance and discipline
• Handle conflict resolution within the team
• Ensure staff adherence to schedules and targets
• Support training initiatives and coaching with coaches
• Provide input into performance reviews