Head of Claims Operations – Health Insurance

Johannesburg, South AfricaFull-timeExecutiveOn-sitePosted 6 Nov 2026

Job Overview

A health insurance business in Johannesburg North is seeking a Head of Claims Operations to formulate and execute its claims operations strategy and own the end-to-end claims lifecycle against agreed service levels, quality standards and cost-optimisation targets (permanent).

The role leads capacity and workforce planning, Lean process improvement, claims transformation with BSO/IT/Systems teams, adjudication integrity and operational risk governance, while building a high-performing, customer-centric claims team and partnering with senior leaders across Technology, Risk, Compliance, Finance and Customer Experience.

Key Responsibilities

• Formulate and execute a Claims Operations strategy aligned with business objectives

• Oversee the end-to-end claims lifecycle against SLAs, quality standards and cost targets

• Establish, monitor and report operational KPIs, SLAs and performance metrics

• Lead resource allocation, workforce optimisation and capacity planning

• Identify bottlenecks and implement Lean practices for productivity and operational excellence

• Partner with BSO, IT and Systems teams on technology enhancements and operating-model upgrades

• Lead claims transformation and business readiness for new products, regulatory shifts and systems

• Ensure claims are assessed and settled accurately, fairly and within underwriting rules

• Embed internal controls and escalation governance; analyse claims and complaint trends

• Recruit, mentor and retain a high-performing claims team

Required Qualifications

• Bachelor's degree in Business Management, Insurance, Finance, Operations, Risk Management or related

• Postgraduate degree in Business, Operations or Risk advantageous

• ACII (or equivalent), Lean Six Sigma or BPM certification advantageous

• 10+ years in health insurance or medical scheme claims

• 5+ years in senior management / executive leadership managing large operational teams

• Claims management (7–8 yrs), health insurance products (8–9 yrs) and claims investigations (6–7 yrs)

Skills & Requirements

Claims ManagementHealth InsuranceMedical Scheme ClaimsClaims InvestigationsOperational StrategyLean Six SigmaWorkforce PlanningKPI & SLA ManagementChange ManagementRisk & GovernanceStakeholder ManagementTeam Leadership