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GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS)
SPECIALIST MEDICINE BENEFIT MANAGEMENT
- Pretoria
- Permanent
- Full Time
- Published: 4 days ago
- Disabled, EE/AA, Non EE/AA
Introduction
The position of Specialist Medicine Benefit Management is vacant. The Specialist Medicine Benefit Management will report directly to the Manager Medicine Benefit Management and form part of the Healthcare Management Division. The position is based in Pretoria Head Office.
The total remuneration package is R 1 193 734 CTC per annum, based on qualifications and experience.
The closing date for applications will be Thursday, 06 August 2026.
Duties & Responsibilities
- The Specialist Medicine Benefit Management will provide support to the Manager Medicine Benefit Management through the implementation of the following Key Performance areas ( KPAs):
- Assist in managing the administrative and technical functions for Medicine Benefit Management in the Clinical Risk Management business unit;
- Maintain up-to-date records of benefits decisions and policy changes;
- Support administrative processes linked to benefit design and implementation;
- Assist with audits, reporting, and quality assurance activities;
- Ensure that queries and complaints escalated to the Scheme are resolved timeously;
- Chair and coordinate monthly SPN meetings;
- Perform Service Level Agreement quarterly site visits to audit SPN processes and systems; and
- Communicate and implement corrective measures where predetermined objectives are not met.
- Assist the Senior Manager in monitoring Scheme cost targets;
- Collaborate with finance and procurement teams in budget planning for medicine benefit management;
- Monitor drug utilisation against budget forecasts;
- Provide input into cost-effectiveness and value-based procurement of pharmaceuticals;
- Support in the management of divisional budget in line with budget allocation;
- Assist in improving member value by ensuring correct adjudication of claims; and
- Facilitate engagements with pharmaceutical manufacturers.
- Maintain regular and scheduled communication with identified stakeholders;
- Assist with the review and update of documents, including clinical reports, protocols, and guidelines
- Respond to queries from stakeholders, including healthcare professionals and funders; and
- Ensure proper documentation of decisions and rationale for audit and compliance.
- Manage all projects for Medicine Benefit Management undertaken by the Scheme;
- Plan, execute, and monitor projects related to medicine benefits;
- Develop project timelines and deliverables;
- Support the Scheme’s Project Management functions
- Manage the administrative function in the Divisional Forums;
- Represent the unit in internal and external committees
- Provide technical input and advice on pharmaceutical policy and benefits issues;
- Support the Scheme’s year-end benefits implementation process.
- Conduct ongoing reviews of the Scheme’s business processes in relation to access to medicine benefits.
- Represent the unit in internal and external committees
- Develop and implement a testing framework for correct medicine claims payment processes by the Administrator;
- Develop and implement a plan for testing inter-SPN interfaces;
- Conduct ongoing reviews of Service Provider Network business processes as they relate to medicine benefits and foster collaboration across the different service providers;
- Support all operational reviews with accurate qualitative and quantitative analyses;
- Review weekly, monthly, and quarterly SPN reports (including ad hoc projects);
- Develop and produce scheduled monthly and quarterly operational reports;
- Medicine Claims Data analysis and use of data to implement corrective action and optimise processes;
- Ensure optimisation of the Scheme’s medicine processes; and
- Fulfil various stakeholder engagements as mandated by the Senior Manager.
- Monitor and manage compliance with the Medical Schemes Act and Regulations and other Pharmaceutical Services related regulations;
- Represent the unit in internal and external committees
- Provide technical input and advice on pharmaceutical policy and medicine benefits issues;
- Present evidence-based recommendations;
- Monitor all industry developments and keep the Senior Manager timeously informed;
- Manage the implementation of the on-boarding of service providers;
- Assist in the management of relevant operational risks internally and within the Service Provider Network; and
- Monitor and assist in the management of Business Unit audit undertakings.
Desired Experience & Qualification
Qualification Requirements are:
- Bachelor of Pharmacy (B Pharm) or related degree in Medical/Clinical Sciences is essential
- Postgraduate qualification in Pharmaco-economics, Health Policy, Public Health, or related field is advantageous; and
- Registration with the relevant statutory council
- Minimum 5 years’ experience in a Managed Care, Pharmaceutical Benefit Management Operational environment, formulary development, or health technology assessment;
- Strong background in managed healthcare, public or private sector pharmaceutical services;
- Experience in policy development and implementation; and
- Proven experience working with multidisciplinary teams and stakeholders
Essential
- Solid Medicine Benefits Operations experience and Medical Schemes operational insight;
- Analytical thinking and problem solving;
- Attention to detail;
- Strategic and critical thinking;
- Strong interpersonal skills;
- Ethical conduct and professionalism;
- Adaptability and innovation;
- Collaboration and team orientation;
- Thrive in a fast-paced environment;
- Analytical with excellent written and verbal communication;
- Must be in possession of a valid driver’s license and own vehicle, and be willing to travel at short notice.
Desirable:
- Have an understanding of the medical schemes industry.
Interested?
GEMS employs people with the highest level of integrity – submission to the appropriate pre-employment assessment is obligatory to be considered for the position.
Kindly note that the information provided on application of the position may be shared with a third party for vetting purposes and will be stored by GEMS for a period of 5 years.
Kindly note that information is required for Employment Equity Purposes and information gathered is strictly used according to the intended purpose of collection, unless there is a legal need or permission is granted from the applicant themselves to make use of it for other purpose.
Should you wish to have your information removed from the GEMS database, kindly send a request in writing to jobs@gems.gov.za.
GEMS adopts a hybrid work model.
GEMS is guided by the principles of employment equity. Preference will be given to groups who are underrepresented in accordance with GEMS employment equity plan.
Successful candidates will be required to seek approval to conduct other work outside of GEMS.
GEMS Employees are required to conduct themselves in a manner that reflects the organisation's paramount values: Excellence, Member Value, Integrity, Innovation, and Collaboration.
CLIENT LIAISON OFFICER
- North West
- Permanent
- Full Time
- EE/AA, Non EE/AA
Introduction
The position of Client Liaison Officer is vacant. The Client Liaison Officer will report directly to the Team Leader and form part of the Client Liaison Division. The position is based in North West and the successful candidates will be responsible for servicing the Mogwase district and Zeerust area.
The total remuneration package is R 503 635 CTC per annum, based on qualifications and experience.
The closing date for applications will be Thursday, 06 August 2026.
Duties & Responsibilities
The Client Liaison Officer will provide support to the Team Leader through the implementation of the following Key Performance areas ( KPAs):
- Visit, interact and assist members in Departments and other public service office as when required.
- Facilitate meetings and one-on-one sessions in an effort to resolve administrative issues encountered by members.
- Receive Scheme correspondence from members and submit to the Administrative team on a daily basis.
- Follow up with members on outstanding information or documents required by the Scheme finalise business processes.
- Assist the marketing service provider at marketing events by attending to member queries.
- Attempt to resolve all queries at first contact.
- Log all resolved and unresolved queries on a daily basis for reporting purposes.
- Compile a daily activity report.
- Escalate all unresolved queries to the admin team through the team leader on a daily basis.
- Represent GEMS well at all times in line with the mission, vision and values.
- Maintain positive Scheme member and stakeholder relationships.
- Facilitate effective communication between members and the Scheme.
- Compile weekly, monthly and quarterly activity reports for submission to the Team Leader.
- Provide ad hoc information when requested.
- Have extensive Scheme and operational knowledge to assist in resolving member queries.
- Must have the ability to use a computer and required systems to resolve member queries; and
- Market the Scheme to potential members and assist in enrolling them on the Scheme.
- Advice process followed in rendering advice and intermediary services (under the supervision of a Key Individual (KI) or Supervisor where applicable)
- Adhere to the stipulations of the supervision agreement and instruction, guidance, and oversight of the FAIS supervisor and KI. (If under supervision)
- Conducting needs analyses for members, providing guidance, and recommendations, and proposing the most suitable benefit option.
- Providing ongoing option advice to members per their individual needs and goals.
- Ensure advice record is comprehensively completed, sent to the member and supervisor/ KI, and stored.
Desired Experience & Qualification
- Matric and NQF5, FAIS accredited qualification (As per FSCA published qualification list), Recommended
- RE5 Advantageous
- At least 2 years of industry experience. (Medical Scheme Industry advantegous)
- Date of First Appointment (DOFA) 2 years with FSCA for 1.16 Health Services Benefits (Advantageous)
- Registered with CMS as a fully accredited broker, (Advantegous)
- No longer under supervision (Advantageous)
- Class of Business Health Benefits (Advantegous)
- If not already,must be willing and able to become a FAIS accredited representative
- Fit and Proper requirements, honesty and integrity, and good standing according to Board Notice 194 of 2017 are adhered to including financial soundness, no criminal record and previous regulatory or employer disciplinary findings.
- Drivers license ( required).
- Own car.
Skills:
- Good written and verbal communication skills.
Behavioural Competencies:
- Passion for customer service.
- Self- motivated and pro-active.
- Attention to detail.
- Team player.
Desirable:
- Have an understanding of the medical schemes industry.
Interested?
GEMS employs people with the highest level of integrity – submission to the appropriate pre-employment assessment is obligatory to be considered for the position.
Kindly note that the information provided on application of the position may be shared with a third party for vetting purposes and will be stored by GEMS for a period of 5 years.
Kindly note that information is required for Employment Equity Purposes and information gathered is strictly used according to the intended purpose of collection, unless there is a legal need or permission is granted from the applicant themselves to make use of it for other purpose.
Should you wish to have your information removed from the GEMS database, kindly send a request in writing to jobs@gems.gov.za.
GEMS adopts a hybrid work model.
GEMS is guided by the principles of employment equity. Preference will be given to groups who are underrepresented in accordance with GEMS employment equity plan.
Successful candidates will be required to seek approval to conduct other work outside of GEMS.
GEMS Employees are required to conduct themselves in a manner that reflects the organisation's paramount values: Excellence, Member Value, Integrity, Innovation, and Collaboration.
