Team Leader: Hospital Risk Management

Recruiter:

Headhunters

Job Ref:

PE003646/DW

Date posted:

Monday, July 13, 2026

Location:

Port Elizabeth, South Africa

Salary:

Monthly

SUMMARY:
Our client in the Financial Services and Insurance industry is seeking to employ a Team Leader: Hospital Risk Management to join their team based in Port Elizabeth.

Purpose of Role:

To lead and support clinical teams in achieving operational and quality performance targets to enhance member health and claims outcomes.

POSITION INFO:
Requirements: Grade 12 \/ Matric is relevant General Nursing Diploma or Degree Must be registered with SANC (South African Nursing Council) as a Registered \/ Professional Nurse A minimum of 3 years' experience in a managed care\/case management environment A minimum of 3 years' clinical experience within a private hospital is essential (ICU and theatre experience is advantageous) Prior leadership experience is advantageous Clinical Auditing experience is advantageous Good understanding of the Medical Scheme industry Proficient in Microsoft Office Responsibilities: Lead and supervise the Case Management and Clinical Claims Auditing teams, ensuring achievement of key performance indicators (KPIs) and service delivery standards. Ensure compliance with all company HR policies and procedures. Provide ongoing training, guidance, and communication to staff regarding benefits, tariffs, scheme rules, and organisational policies and procedures. Support the resolution of complex and escalated case management and clinical audit queries. Manage and investigate complaints received from the Council for Medical Schemes (CMS) and liaise with Fund Managers to ensure effective resolution. Monitor, analyse, and report on weekly operational and performance metrics, implementing corrective actions and continuous improvement initiatives where required. Assist Fund Managers with the compilation of information and preparation of reports and presentations for meetings and stakeholder engagements. Review and analyse workflow processes to identify efficiencies, enhance productivity, and ensure process relevance and effectiveness. Ensure all operational, audit, and performance reports are reviewed, validated, and appropriately actioned within agreed timelines. Please note that if you do not receive a response within 2 weeks, your application has been unsuccessful.

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