Head: Claims Risk Management

Position Details

• Title: Head: Claims Risk Management
• Location: Sandton, Gauteng
• Industry: Managed Care
• Reference: MCP:JHB-HCRM

About

A leading healthcare organisation is seeking an experienced Head: Claims Risk Management to oversee its Health Investigations Unit. The role is responsible for driving claims risk governance, ensuring regulatory alignment, and delivering exceptional service to internal and external stakeholders.

Key Responsibilities

• Lead and manage the Health Investigations Unit, ensuring compliance with legal, regulatory, and service‑level requirements.
• Strengthen risk, governance, and quality frameworks across claims processes.
• Drive process optimisation, operational efficiency, and continuous improvement.
• Build strong stakeholder relationships and enhance client service delivery.
• Lead, mentor, and develop a high‑performing team.
• Oversee financial controls, budgeting, and risk‑related reporting.
• Manage complex claims risk matters and contribute to policy development.

Requirements

• Matric and a relevant bachelor’s degree (business, finance, risk, compliance).
• 5–8 years’ experience in risk or compliance, with 2–3 years in leadership.
• Experience in the finance or insurance sector.
• Strong knowledge of risk management, governance, financial controls, and quality frameworks.
• Exposure to Lean Six Sigma or similar methodologies advantageous.
• Healthcare industry knowledge beneficial.
• Professional certifications related to risk management and compliance (e.g., Certified Risk Manager (CRM), Certified Compliance & Ethics Professional (CCEP), Certified Internal Auditor (CIA), Certified in Risk and Information Systems Control (CRISC), and Certified Regulatory Compliance Manager (CRCM)) – desirable.

Competencies

• Strategic thinking
• Decision‑making
• Leadership
• Integrity
• Task management
• Analytical ability
• Strong communication skills