Location: Centurion, Gauteng

Position Purpose :

To ensure that clinical services meet established quality standards, regulatory requirements, and best practice clinical guidelines. This role drives measurable improvements in member care, clinical outcomes, utilization management, and adherence to statutory frameworks.

Experience: 3–5 years’ experience in clinical quality assurance, auditing, utilisation management, medical claims review, or related healthcare quality role within a medical aid / medical scheme / healthcare funder environment. Solid understanding of South African healthcare regulatory frameworks (CMS, PMBs, risk adjustment). >Qualifications: Matric Bachelor’s degree in nursing or related healthcare qualification. Post-graduate qualification in Quality Management will be advantageous. KEY COMPETENCIES Strong clinical auditing and analytical skills. Knowledge of clinical coding systems (ICD-10, CPT ...