PMB Specialist – Healthcare Claims

About the role

Join a growing healthcare technology and medical claims business that values learning, accountability and collaboration. As a PMB Specialist you will manage specialist review of PMB claims, ensuring compliance with scheme requirements and driving resolutions.

Key responsibilities

• Take ownership of PMB claims identified for specialist review and submit applications with supporting documents.
• Assess claims against PMB requirements, returning non‑qualifying cases to administrators.
• Collaborate with surgeons and healthcare providers to obtain clinical notes, ICD‑10 codes and other supporting information.
• Monitor scheme turnaround times and follow up promptly when review periods expire.
• Investigate payment differences, challenge incorrect rejections and escalate unresolved matters through appropriate medical scheme channels.
• Prepare and manage formal complaints to the Council for Medical Schemes when obligations are not met.

Required profile

• 2–3 years of experience in healthcare or medical claims industry.
• Matric qualification; an administrative qualification is advantageous.
• Strong ownership mindset with the ability to work independently and within a team.
• Resilient and tenacious when handling difficult claims or rejected submissions.

Required skills

• Strong working knowledge of the PMB process.
• Good computer literacy, numeracy and typing skills.
• Ability to prepare clear claim information for queries and regulatory escalations.
• Analytical and problem‑solving abilities with excellent attention to detail.

What we offer

• Competitive monthly salary ranging from R18 000 to R20 000, based on qualifications and experience.