PMB Specialist

SUMMARY:
Join a growing healthcare technology and medical claims business with a culture built around learning, accountability, openness and collaboration. This is an environment for people who want to keep improving, take ownership of their work and build deeper specialist knowledge over time.

POSITION INFO:

A key summary of the role is outlined below. A more comprehensive job specification with full details is available after initial contact and a successful CV review.
Duties / Key Responsibilities

• Take ownership of PMB claims once they have been identified for specialist review.
• Complete and submit PMB applications and scheme-specific supporting documents.
• Assess whether claims meet PMB requirements and return non-qualifying cases to the relevant administrator.
• Work with surgeons and other healthcare providers to obtain clinical notes, ICD-10 codes and supporting information.
• Track scheme turnaround times and follow up promptly when review periods expire.
• Investigate payment differences and challenge incorrect PMB rejections or funding decisions.
• Escalate unresolved matters through the appropriate medical scheme channels, including Principal Officers where required.
• Prepare and manage formal complaints to the Council for Medical Schemes when PMB obligations are not being met.

Requirements

• 2–3 years' relevant healthcare or medical claims industry experience.
• Strong working knowledge of the PMB process.
• Good computer literacy, numeracy and typing skills.
• Able to prepare clear claim information for medical scheme queries and regulatory escalations.
• Strong analytical and problem-solving ability.
• Excellent attention to detail.
• Comfortable challenging medical scheme decisions and following matters through to resolution.

Education

• Matric is required.
• A relevant administrative qualification would be advantageous.

Soft Skills

• Strong ownership mindset with the drive to see issues through.
• Clear, confident communicator with a client-focused approach.
• Resilient and tenacious when dealing with difficult claims or rejected submissions.
• Able to work independently while contributing well within a team.
• Comfortable following structured processes while also spotting opportunities to improve them.
• Adaptable, curious and keen to keep learning as the role and team continue to evolve.

Salary

The salary will be market related based on qualifications, skills, and experience. The proposed salary range is R18,000 - R20,000 per month.