Membership Clerk: Quality Controller

Medshield Medical Scheme

Gauteng, South Africa


Sep 2

To perform quality control activities on all workflow transactions to ensure accuracy in data entry and adherence to Standard Operating Procedures and Scheme rules within the agreed Service Levels. -Check and verify the accuracy and completeness of data captured on workflow against the application forms and ensure correctness. -Check and verify that the clinical underwriting that was applied by the underwriter is accurate and in line with the Scheme underwriting Rules and Medical Scheme Legislation.-Coach staff on errors identified.-Activate application forms upon QC completion.-Investigate, and resolve customer queries in accordance with Standard Operating Procedures within the agreed Service Levels and providing feedback to the query requester on the outcome of the query.-Assist with compiling of monthly membership reports and adhere to set reporting standards.-Provide sub-divisional training and coaching for team members to enhance data integrity and business optimisation. -Ensure the Membership sub-division has a thorough understanding of the Medical Schemes Act principles and regulatory provisioning guidelines.-Identify areas of improvement to increase speed, quality and gain efficiencies.-Recommend improvements and identify gaps in Standards Operating Procedures relating to Membership.-Assist in identifying and adhering to fraud controls, risk prevention principles, sound governance and compliance processes, and tools to identify and manage risks.-Support and provide evidence to all internal, external and ISO audit requirements.-Maintain quality risk management standards in line with the requirements from ISO9001:2015.-Maintain and enforce all membership related Service Level Agreements to minimise business risk and ensure business continuity. -Identify and recommend improvements to credit control related Standard Operating Procedures and guidelines in consultation with the Supervisor and Manager: Membership to ensure business optimisations. -Adhere to all relevant laws, policies and Standard Operating Procedures throughout the organisation-Build and maintain effective internal and external stakeholder relationships for the purpose of expectations management, knowledge sharing and integration. -Liaise with members, brokers and 3rd parties in delivering exceptional customer service.

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