Location: Centurion, Gauteng

Position Purpose: The Onboarding Quality Controller & Underwriter ensures that members joining the medical scheme are onboarded accurately, efficiently and in compliance with regulatory requirements. This role safeguards data integrity, enhances member experience and supports operation excellence by monitoring and improving the quality of onboarding processes.   

 Qualifications/Experience:

• Matric (Grade 12) required; tertiary qualification in administration, healthcare, or business advantageous.
• 3–5 years’ experience in administration or membership processing (preferably in medical aid/insurance).
• Strong knowledge of medical aid schemes and regulatory requirements.
  
  

KEY COMPETENCIES 

• Must understand the Medical Schemes Act (no 131 of 1998) and its implications for underwriting practices
• Familiarity with Prescribed Minimum Benefits (PMBs) and how they affect risk assessment.
• Verify accuracy and completeness of new member applications, supporting documents and medical declarations.
• Conduct audit s of onboarding processes to ensure compliance of internal policies, the Medical schemes act, and Council of Medical Schemes (CMS) guidelines.
• Identify errors, inconsistencies or risks in data capture and recommend corrective actions.
• Provide feedback and training to onboarding staff to improve accuracy and efficiency
• Generate quality control reports highlighting trends, recurring issues and areas of improvement.
• Ensure al underwriting decisions comply with the Medical Schemes Act, Council of Medical Schemes (CMS) regulations, and internal policies
• Maintain accurate records of underwriting decision and communicate outcomes to brokers, members and internal teams
• Work Closely with internal stake holders to ensure consistency in risk management
• Monitor industry trend, fraud risk, and regulatory changes to refine underwriting practices.
• Communicate with relevant parties to keep them informed of the status of their requests
• Maintain accurate and up-to-date membership records.
• Verify documentation for compliance with medical aid regulations.
• Ensure confidentiality and security of member information.
• Maintain accurate records of all administration performed on membership within company standards
• Ensure records are organized and accessible for audits and reference

Skills and Abilities 

• Analytical mindset with attention to detail
• Strong administrative and organizational skills.
• Attention to detail and accuracy in data entry.
• Good communication and interpersonal abilities.
• Knowledge of medical aid products, benefits, and industry regulations.
• Ability to work under pressure and meet deadlines.
• Ability to manage multiple tasks, prioritize workloads, follow up on outstanding queries and maintain organized records
• Strong verbal and written communication skills for interacting with members, brokers and internal teams.
• Focused on providing excellent service to internal and external stakeholders and addressing concerns effectively.
• Awareness of relevant regulations and standards governing medical aids
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint).

Note: Company reserves the right to close the advert before specified closing date.