Specialist Medicine Benefit Management – Healthcare Management

About the role

The Specialist Medicine Benefit Management role supports the Manager of Medicine Benefit Management within the Healthcare Management Division of GEMS. Based at the Pretoria head office, the role focuses on administering and improving the scheme’s medicine benefit programmes, ensuring compliance, cost‑effectiveness and high‑quality service to members.

Key responsibilities

• Assist in managing administrative and technical functions for Medicine Benefit Management, maintaining up‑to‑date records of benefit decisions and policy changes.
• Support benefit design, implementation, audits, reporting and quality‑assurance activities.
• Resolve escalated queries and complaints in a timely manner and chair monthly SPN meetings.
• Conduct quarterly SLA site visits, audit SPN processes and implement corrective actions.
• Monitor scheme cost targets, collaborate with finance and procurement on budget planning, and track drug utilisation against forecasts.
• Provide input on cost‑effectiveness and value‑based procurement of pharmaceuticals.
• Facilitate engagements with pharmaceutical manufacturers and maintain regular stakeholder communication.
• Manage projects related to medicine benefits, develop timelines and deliverables, and support the scheme’s project‑management functions.
• Represent the unit in internal and external committees and provide technical advice on pharmaceutical policy.

Required profile

• Experience in healthcare benefit administration, pharmaceutical policy or related medical‑benefit management.
• Strong analytical ability to monitor budgets, drug utilisation and cost targets.
• Excellent communication skills for stakeholder engagement and complaint resolution.
• Project‑management experience, including planning, execution and monitoring of benefit‑related initiatives.
• Ability to work collaboratively with finance, procurement and clinical teams.

Required skills

• No specific technical skills were listed in the posting.

What we offer

• Total remuneration package of R 1 193 734 CTC per annum.
• Full‑time permanent position based in Pretoria.
• Opportunity to influence medicine benefit strategy within a major public medical scheme.