About the position
Introduction
The position of Senior Manager: Clinical and Transaction Services is vacant. The Senior Manager: Clinical and Transaction Services will report directly to the Chief Administration Officer and form part of the Administration and Transaction Services (ATS) division. The position is based at Head Office.
The total remuneration package will be R 2 016 382 per annum dependent on skills and experience
The closing date for applications will be Thursday, 18 December 2025.
Duties & Responsibilities
The Senior Manager: Clinical and Transaction Services will be required to provide support to the Chief Administration Officer through the implementation of the following Key Performance Areas (KPAs):
- Manage the performance of contracted stakeholders :
- Oversee an annual review of SPN contracts
- Manage the performance of the Scheme's SPN.
- Oversee seamless clinical and transactional integration across the SPN
- Manage the development, review and maintenance of SOP's and business processes.
- Set and monitor annual performance targets for SPN members.
- Manage the development and maintenance of service level performance and contracting.
- Oversee the implementation of clinical and transactional standards against the Scheme's business requirements.
- Manage the development and maintenance of service level performance.
- Oversee the implementation of clinical and transactional standards against the Scheme's business requirements.
- Monitor and assess contracted provider business processes regularly.
- Manage the review and recommendation of SPN contract renewals
- Manage the compliance of regularity requirements by the SPN.
- Attendance of the SPN related Forum specifically Claims and Service management forums
- Identify and recommend SPN non-performance penalties
- Continuously identify and recommend areas where performance efficiencies can be realised.
Minimum Requirements
- Clinical Sciences Qualification, e.g Bcur; Bpharm or equivalent NQF Level 7
- Postgraduate qualification in Contract Management is required
- At least 8 years of functional work experience with 5 years Management experience in clinical claims management and an understanding of coding and billing rules interpretation
- A good understanding of all coding (Nappi, Tariffs, ICD10, CPT4, UPFS and more) is a must
Skills
- Self-motivated with the ability to prioritize, meet deadlines, and manage changing priorities;
- Ability to read and comprehend strategic documents
- Proven ability to be flexible and work hard, both independently and in a team environment;
- Must be in possession of a valid driver's license and own vehicle, and be willing to travel at short notice
- Ability to give direction and engage with various stakeholders
- Excellent computer literacy and MS Office skills, including Microsoft Project;
- Experience in System Development Life Cycle is advantageous
- Sound qualitative and quantitative analysis skills;
- Excellent communication and writing skills;
- Strong analytical skills with attention to detail;
Behavioural Competencies:
Desirable
- Have an understanding of the medical schemes industry/ Experience in the Healthcare Industry would be advantageous
Interested?
GEMS employs people with the highest level of integrity - submission to the appropriate pre-employment assessment is obligatory to be considered for the position.
Kindly note that the information provided on application of the position may be shared with a third party for vetting purposes and will be stored by GEMS for a period of 5 years.
Kindly note that information is required for Employment Equity Purposes and information gathered is strictly used according to the intended purpose of collection, unless there is a legal need or permission is granted from the applicant themselves to make use of it for other purpose
Should you wish to have your information removed from the GEMS database, kindly send a request in writing to [Email Address Removed] .
GEMS adopts a hybrid work model
GEMS is guided by the principles of employment equity. Preference will be given to groups who are underrepresented in accordance with GEMS employment equity plan.
An employee must be in their current role for at 12 months before they will be considered for other vacancies within the Scheme.
GEMS reserves the right not to proceed with an appointment.
Successful candidates will be required to seek approval to conduct other work outside of GEMS.
GEMS Employees are required to conduct themselves in a manner that reflects the organisation's paramount values: Excellence, Member Value, Integrity, Innovation, and Collaboration.
