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Specialist Medicine Benefit Management
Introduction
The position of Specialist Medicine Benefit Management is vacant. The Specialist Medicine Benefit Management will report directly to the Manager Medicine Benefit Management and form part of the Healthcare Management Division. The position is based in Pretoria Head Office.
The total remuneration package is R 1 193 734 CTC per annum, based on qualifications and experience.
The closing date for applications will be Thursday, 06 August 2026.
Duties & Responsibilities
- The Specialist Medicine Benefit Management will provide support to the Manager Medicine Benefit Management through the implementation of the following Key Performance areas ( KPAs):
- Assist in managing the administrative and technical functions for Medicine Benefit Management in the Clinical Risk Management business unit;
- Maintain up-to-date records of benefits decisions and policy changes;
- Support administrative processes linked to benefit design and implementation;
- Assist with audits, reporting, and quality assurance activities;
- Ensure that queries and complaints escalated to the Scheme are resolved timeously;
- Chair and coordinate monthly SPN meetings;
- Perform Service Level Agreement quarterly site visits to audit SPN processes and systems; and
- Communicate and implement corrective measures where predetermined objectives are not met.
- Assist the Senior Manager in monitoring Scheme cost targets;
- Collaborate with finance and procurement teams in budget planning for medicine benefit management;
- Monitor drug utilisation against budget forecasts;
- Provide input into cost-effectiveness and value-based procurement of pharmaceuticals;
- Support in the management of divisional budget in line with budget allocation;
- Assist in improving member value by ensuring correct adjudication of claims; and
- Facilitate engagements with pharmaceutical manufacturers.
- Maintain regular and scheduled communication with identified stakeholders;
- Assist with the review and update of documents, including clinical reports, protocols, and guidelines
- Respond to queries from stakeholders, including healthcare professionals and funders; and
- Ensure proper documentation of decisions and rationale for audit and compliance.
- Manage all projects for Medicine Benefit Management undertaken by the Scheme;
- Plan, execute, and monitor projects related to medicine benefits;
- Develop project timelines and deliverables;
- Support the Scheme’s Project Management functions
- Manage the administrative function in the Divisional Forums;
- Represent the unit in internal and external committees
- Provide technical input and advice on pharmaceutical policy and benefits issues;
- Support the Scheme’s year-end benefits implementation process.
- Conduct ongoing reviews of the Scheme’s business processes in relation to access to medicine benefits.
- Represent the unit in internal and external committees
- Develop and implement a testing framework for correct medicine claims payment processes by the Administrator;
- Develop and implement a plan for testing inter-SPN interfaces;
- Conduct ongoing reviews of Service Provider Network business processes as they relate to medicine benefits and foster collaboration across the different service providers;
- Support all operational reviews with accurate qualitative and quantitative analyses;
- Review weekly, monthly, and quarterly SPN reports (including ad hoc projects);
- Develop and produce scheduled monthly and quarterly operational reports;
- Medicine Claims Data analysis and use of data to implement corrective action and optimise processes;
- Ensure optimisation of the Scheme’s medicine processes; and
- Fulfill various stakeholder engagements as mandated by the Senior Manager.
- Monitor and manage compliance with the Medical Schemes Act and Regulations and other Pharmaceutical Services related regulations;
- Represent the unit in internal and external committees
- Provide technical input and advice on pharmaceutical policy and medicine benefits issues;
- Present evidence-based recommendations;
- Monitor all industry developments and keep the Senior Manager timeously informed;
- Manage the implementation of the on-boarding of service providers;
- Assist in the management of relevant operational risks internally and within the Service Provider Network; and
- Monitor and assist in the management of Business Unit audit undertakings.
Desired Experience & Qualification
Qualification Requirements are:
- Bachelor of Pharmacy (B Pharm) or related degree in Medical/Clinical Sciences is essential
- Postgraduate qualification in Pharmaco-economics, Health Policy, Public Health, or related field is advantageous; and
- Registration with the relevant statutory council
- Minimum 5 years’ experience in a Managed Care, Pharmaceutical Benefit Management Operational environment, formulary development, or health technology assessment;
- Strong background in managed healthcare, public or private sector pharmaceutical services;
- Experience in policy development and implementation; and
- Proven experience working with multidisciplinary teams and stakeholders
Essential
- Solid Medicine Benefits Operations experience and Medical Schemes operational insight;
- Analytical thinking and problem solving;
- Attention to detail;
- Strategic and critical thinking;
- Strong interpersonal skills;
- Ethical conduct and professionalism;
- Adaptability and innovation;
- Collaboration and team orientation;
- Thrive in a fast-paced environment;
- Analytical with excellent written and verbal communication;
- Must be in possession of a valid driver’s license and own vehicle, and be willing to travel at short notice.
Desirable:
- Have an understanding of the medical schemes industry.
Click here to apply
Client Liaison Officer – East London
Introduction
The position of Client Liaison Officer is vacant. The Client Liaison Officer will report directly to the Team Leader and form part of the Client Liaison Division. The position is based in East London and the successful candidate will be responsible for servicing the Joe Gqabi District.
The total remuneration package is R 503 635 CTC per annum, based on qualifications and experience.
The closing date for applications will be Thursday, 06 August 2026.
Duties & Responsibilities
The Client Liaison Officer will provide support to the Team Leader through the implementation of the following Key Performance areas ( KPAs):
- Visit, interact and assist members in Departments and other public service office as when required.
- Facilitate meetings and one-on-one sessions in an effort to resolve administrative issues encountered by members.
- Receive Scheme correspondence from members and submit to the Administrative team on a daily basis.
- Follow up with members on outstanding information or documents required by the Scheme finalise business processes.
- Assist the marketing service provider at marketing events by attending to member queries.
- Attempt to resolve all queries at first contact.
- Log all resolved and unresolved queries on a daily basis for reporting purposes.
- Compile a daily activity report.
- Escalate all unresolved queries to the admin team through the team leader on a daily basis.
- Represent GEMS well at all times in line with the mission, vision and values.
- Maintain positive Scheme member and stakeholder relationships.
- Facilitate effective communication between members and the Scheme.
- Compile weekly, monthly and quarterly activity reports for submission to the Team Leader.
- Provide ad hoc information when requested.
- Have extensive Scheme and operational knowledge to assist in resolving member queries.
- Must have the ability to use a computer and required systems to resolve member queries; and
- Market the Scheme to potential members and assist in enrolling them on the Scheme.
- Advice process followed in rendering advice and intermediary services (under the supervision of a Key Individual (KI) or Supervisor where applicable)
- Adhere to the stipulations of the supervision agreement and instruction, guidance, and oversight of the FAIS supervisor and KI. (If under supervision)
- Conducting needs analyses for members, providing guidance, and recommendations, and proposing the most suitable benefit option.
- Providing ongoing option advice to members per their individual needs and goals.
- Ensure advice record is comprehensively completed, sent to the member and supervisor/ KI, and stored.
Desired Experience & Qualification
- Matric and NQF5, FAIS accredited qualification (As per FSCA published qualification list), Recommended
- RE5 Advantageous
- At least 2 years of industry experience. (Medical Scheme Industry advantegous)
- Date of First Appointment (DOFA) 2 years with FSCA for 1.16 Health Services Benefits (Advantageous)
- Registered with CMS as a fully accredited broker, (Advantegous)
- No longer under supervision (Advantageous)
- Class of Business Health Benefits (Advantegous)
- If not already,must be willing and able to become a FAIS accredited representative
- Fit and Proper requirements, honesty and integrity, and good standing according to Board Notice 194 of 2017 are adhered to including financial soundness, no criminal record and previous regulatory or employer disciplinary findings.
- Drivers license ( required).
- Own car.
Skills:
- Good written and verbal communication skills.
Behavioural Competencies:
- Passion for customer service.
- Self- motivated and pro-active.
- Attention to detail.
- Team player.
Desirable:
- Have an understanding of the medical schemes industry.
Click here to apply
Client Liaison Officer – North West
Introduction
The position of Client Liaison Officer is vacant. The Client Liaison Officer will report directly to the Team Leader and form part of the Client Liaison Division. The position is based in North West and the successful candidates will be responsible for servicing the Mogwase district and Zeerust area.
The total remuneration package is R 503 635 CTC per annum, based on qualifications and experience.
The closing date for applications will be Thursday, 06 August 2026.
Duties & Responsibilities
The Client Liaison Officer will provide support to the Team Leader through the implementation of the following Key Performance areas ( KPAs):
- Visit, interact and assist members in Departments and other public service office as when required.
- Facilitate meetings and one-on-one sessions in an effort to resolve administrative issues encountered by members.
- Receive Scheme correspondence from members and submit to the Administrative team on a daily basis.
- Follow up with members on outstanding information or documents required by the Scheme finalise business processes.
- Assist the marketing service provider at marketing events by attending to member queries.
- Attempt to resolve all queries at first contact.
- Log all resolved and unresolved queries on a daily basis for reporting purposes.
- Compile a daily activity report.
- Escalate all unresolved queries to the admin team through the team leader on a daily basis.
- Represent GEMS well at all times in line with the mission, vision and values.
- Maintain positive Scheme member and stakeholder relationships.
- Facilitate effective communication between members and the Scheme.
- Compile weekly, monthly and quarterly activity reports for submission to the Team Leader.
- Provide ad hoc information when requested.
- Have extensive Scheme and operational knowledge to assist in resolving member queries.
- Must have the ability to use a computer and required systems to resolve member queries; and
- Market the Scheme to potential members and assist in enrolling them on the Scheme.
- Advice process followed in rendering advice and intermediary services (under the supervision of a Key Individual (KI) or Supervisor where applicable)
- Adhere to the stipulations of the supervision agreement and instruction, guidance, and oversight of the FAIS supervisor and KI. (If under supervision)
- Conducting needs analyses for members, providing guidance, and recommendations, and proposing the most suitable benefit option.
- Providing ongoing option advice to members per their individual needs and goals.
- Ensure advice record is comprehensively completed, sent to the member and supervisor/ KI, and stored.
Desired Experience & Qualification
- Matric and NQF5, FAIS accredited qualification (As per FSCA published qualification list), Recommended
- RE5 Advantageous
- At least 2 years of industry experience. (Medical Scheme Industry advantegous)
- Date of First Appointment (DOFA) 2 years with FSCA for 1.16 Health Services Benefits (Advantageous)
- Registered with CMS as a fully accredited broker, (Advantegous)
- No longer under supervision (Advantageous)
- Class of Business Health Benefits (Advantegous)
- If not already,must be willing and able to become a FAIS accredited representative
- Fit and Proper requirements, honesty and integrity, and good standing according to Board Notice 194 of 2017 are adhered to including financial soundness, no criminal record and previous regulatory or employer disciplinary findings.
- Drivers license ( required).
- Own car.
Skills:
- Good written and verbal communication skills.
Behavioural Competencies:
- Passion for customer service.
- Self- motivated and pro-active.
- Attention to detail.
- Team player.
Desirable:
- Have an understanding of the medical schemes industry.
Click here to apply
Innovation Specialist
Introduction
The position of Innovation Specialist is vacant. The Innovation Specialist will report directly to the Senior Manager: Strategy and forms part of the Office of the Principal Officer Division. The position is based at Head Office in Pretoria.
The total remuneration package for this position will be between R 954,930 and R1,193,734 per annum, based on qualifications and experience.
The closing date for applications will be Tuesday, 28 July 2026.
Overview:
The Innovation Specialist will support the implementation of the GEMS Innovation Strategy by driving innovation initiatives, coordinating projects, and promoting a culture of continuous improvement across the organisation. The role requires strong analytical, project coordination, and stakeholder engagement skills to translate ideas and trends into practical innovation opportunities. A relevant degree and at least five years’ experience in innovation, strategy, or business improvement are essential.
Duties & Responsibilities
The Innovation Specialist will be required to provide support to the Senior Manager: Strategy in the Office of the Principal Officer on the implementation and operationalisation of the GEMS Innovation Strategy and Innovation Management Framework, including the embedding of an innovation culture and continuous improvement practices across the Scheme, through the following:
- Support implementation and operationalisation of the GEMS Innovation Strategy and Innovation Management Framework.
- Coordinate innovation management processes, governance activities and Innovation Committee processes.
- Coordinate the intake, evaluation, prioritisation and tracking of innovation ideas, unsolicited proposals, initiatives and projects across Business-as-Usual (BAU), Tactical and Strategic innovation categories.
- Conduct innovation research, environmental scanning and benchmarking on healthcare, digital, operational and regulatory trends.
- Analyse operational, member and stakeholder insights to identify innovation and continuous improvement opportunities.
- Support development of innovation business cases, concept papers, proposals and governance submissions.
- Coordinate innovation initiatives, pilot projects and implementation activities across the Scheme.
- Facilitate collaboration and stakeholder engagement with internal divisions, service providers, strategic partners and external stakeholders.
- Coordinate innovation workshops, ideation sessions, communication and stakeholder engagement activities.
- Support organisational change management, innovation adoption and the embedding of an innovation culture across the Scheme.
- Support implementation of Design Thinking, Agile and continuous improvement practices.
- Prepare innovation reports, dashboards, presentations and progress updates.
- Monitor innovation KPIs, implementation progress and benefits realisation.
- Maintain innovation registers, reporting records and governance documentation.
- Support identification and mitigation of risks and issues related to innovation initiatives.
Desired Experience & Qualification
Qualification and experience requirements are:
- Minimum 3-year Degree in Innovation Management, Strategy Management, Business Management, Healthcare Management, Engineering, Information Systems or equivalent qualification.
- A postgraduate qualification in Innovation Management, Strategy, Business Management or related fields will be advantageous.
- Minimum 5 years’ relevant experience in innovation management, strategy execution, project coordination, business improvement, transformation management or related strategic and operational support roles.
- Experience in facilitating cross-functional collaboration and stakeholder engagements.
- Experience in innovation reporting, dashboard development or innovation performance monitoring will be advantageous.
- Experience in change management and organisational adoption initiatives.
- Exposure to innovation management, digital transformation and continuous improvement initiatives will be advantageous.
- Understanding of innovation management, innovation governance and innovation operating models will be advantageous.
- Understanding of the healthcare funding and medical schemes environment will be advantageous.
Skills and Competencies:
- Strong analytical, critical thinking and problem-solving skills.
- Strong project coordination and stakeholder management capability.
- Research and environmental scanning capability.
- Excellent written, verbal communication, interpersonal and presentation skills.
- Ability to facilitate workshops and stakeholder engagements.
- Ability to coordinate multiple initiatives and competing priorities simultaneously.
- Strong organisational, planning and coordination capability.
- Strategic and conceptual thinking capability.
- Innovation and continuous improvement orientation.
- Ability to translate emerging trends and insights into practical innovation opportunities.
- Demonstrated ability to work effectively as part of a team.
- High levels of professionalism, reliability and attention to detail.
- Self-motivated, proactive and able to work effectively under pressure.
- Advanced MS Office skills, including PowerPoint, Excel and Word.
- Must be in possession of a valid driver’s license and own vehicle and be willing to travel at short notice.
Behavioural Competencies:
- High level of attention to detail and problem-solving ability.
- Demonstrable capability, professionalism and accountability.
- Ability to translate emerging trends and insights into practical innovation opportunities.
- Commitment to continuous improvement, innovation and organisational excellence.
- Strong interpersonal skills and ability to work effectively in cross-functional teams.
- Displays original thinking and innovation in supporting organisational transformation and continuous improvement initiatives.
- Ability to build collaborative relationships and engage effectively with diverse stakeholders.
- Self-motivated, proactive and adaptable in a dynamic working environment.
- Commitment to working in the not-for-profit sector.
Desirable:
- Knowledge of innovation management frameworks, innovation governance processes, organisational innovation implementation and continuous improvement practices.
- Exposure to healthcare, consulting, strategy or transformation environments will be advantageous.
Click here to apply
We wish you all the best with your applications
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