Configuration Specialist

Our client in the Healthcare / Medical Aid Administration Industry is looking to employ a Configuration Specialist to join their team based in Sandton, Gauteng.

Exciting Opportunity:
Join a dynamic healthcare technology environment where you will play a critical role in ensuring accurate system configuration, claims integrity, and seamless medical scheme administration — directly impacting service quality, compliance, and financial protection outcomes.

Requirements

• Matric / Grade 12 (Essential).
• Associated Degree or relevant tertiary qualification (Advantageous).
• 5 – 7 years’ experience in healthcare administration or medical scheme environment.
• In-depth knowledge of medical aid administration processes (benefits, contracts, authorisations, claims processing).
• Strong understanding of medical terminology and benefit structures.
• Knowledge of tariffs, UPFS, and government gazette frameworks – Essential.
• Experience with system configuration, data analysis, or claims administration platforms – Advantageous.
• Knowledge of reporting tools and file formats – Advantageous.
• Strong computer literacy (MS Office, system platforms).
• Excellent analytical, problem-solving, and attention to detail skills.
• Ability to work under pressure and manage multiple priorities.

Responsibilities

System Configuration & Administration

• Configure and maintain O2 system platform settings accurately.
• Translate scheme benefits, contracts, and business rules into system configuration parameters.
• Update and maintain provider contracts, benefit tables, tariffs, and fee schedules.
• Create and maintain network rules, policy rules, and payment structures.
• Load and maintain NAPPI codes, pricing updates, and negotiated rates.

Claims & Audit Control

• Conduct claims testing to prevent financial losses.
• Analyse claims impact and identify potential fraud, waste, and abuse.
• Perform audit sampling and validate system outputs against source documentation.
• Investigate errors and ensure resolution within SLA timelines.
• Prepare audit and operational risk reports.

Business & Stakeholder Support

• Act as escalation point between business and IT teams.
• Provide system and operational guidance to stakeholders and clients.
• Support helpdesk queries and operational system issues.
• Participate in scheme audits with focus on zero audit findings.

Process Improvement & Innovation

• Drive continuous improvement initiatives.
• Participate in new project testing and system development validation.
• Develop test packs and support system implementation projects.
• Document system and business process improvements.

Client Service & Relationship Management

• Maintain strong relationships with internal and external stakeholders.
• Ensure SLA performance standards are achieved.
• Provide expert advisory support on scheme operations.

Financial & Risk Control

• Monitor cost efficiency and operational expenditure.
• Identify risk exposure and recommend mitigation strategies.
• Support financial integrity through accurate system controls.