GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS) VACANCIES

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HEALTHCARE TARIFF AND BILLING SPECIALIST

• Pretoria
• Permanent
• Full Time
• EE/AA, Non EE/AA

 
Introduction
Internal Job Title – Provider Tariffs and Billing Rules Specialist
The position of Provider Tariffs and Billing Rules Specialist is vacant. The Provider Tariffs and
Billing Rules will report directly to the Manager: Provider Tariffs and Billing Rules and forms part of the Healthcare Management Division. The position is based at Head Office in Pretoria.
The remuneration package for this position is R 1 136 890 per annum based on qualifications and experience.
The closing date for applications will be Thursday, 26 March 2026.
 
Duties & Responsibilities
The Provider Tariffs and Billing Rules Specialist will be required to provide support to the Manager: Provider Tariffs and Billing Rules through the implementation of the following Key Performance Areas (KPAs):

• Work closely with the Tariff File Coordinator, Coding, and Clinical Managers to deliver high-quality work.
• Support the Scheme funding decisions through technical review, application, and validation of any changes to the GEMS Master Tariff and Billing Rules Files based on best practice standards.
• Work closely with the Clinical Team to ensure that the GEMS Master Tariff and Billing Rules Files are in accordance with evidence-based medicine and industry dynamics.
• Ensure that Service Provider Networks (SPNs) apply the GEMS Master Tariff and billing Rules Files according to GEMS requirements.
• Evaluate GEMS Master Tariff and billing Rules Files appropriateness and inefficiencies and recommend corrective action.
• Assists in monitoring and managing SPNs’ SLA compliance.
• Identify, assess and mitigate risk.

 
Desired Experience & Qualification
Qualification requirements are:

• Diploma or NQF level 6 qualification.
• Minimum of 3-5 years functional experience.
• Proven experience in tariff coding and billing rules; managed care and/or medical schemes. administration; claims assessing and processing and data handling.
• Team Leader in tariff coding and claims management environment.
• Experience in Stakeholder engagement.
• A good understanding of ICD10, CPT 4, NAPPI and tariff coding.
• Excellent knowledge of NHRPL coding.
• A good understanding of the Medical Schemes Act.
• Strong analytical and administrative skills.
• Strong verbal and written communication and interpersonal skills.
• Good organisational ability and ability to meet tight deadlines.
• Critical thinking skills and the ability to work independently under pressure and as part of a team.
• Quality check and quality assurance skills.
• Must be able to work in a team.
• High-level initiative as a self-starter, reliable and proactive.
• Have resilient pressure management skills.
• Report writing and presentation skills.
• Intermediate to Advanced MS Office skills.
• Sound planning / project management skills.
• Have a diligent work ethic with attention to detail.
• Must be in a position of a driver's license with own vehicle and be willing to travel on short notice.
• Organised and have good time management skills.
• Customer service skills.
• Data analysis skills.

 
Interested?
The closing date for applications is 01 April 2025. Should you not hear from us by 30 April 2025, please consider your application unsuccessful.
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.
 
PLEASE APPLY HERE
 
 
 
 
 
 

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​JUNIOR PROJECTS MANAGER

• Pretoria
• Permanent
• Full Time
• EE/AA, Non EE/AA

 
Introduction
The position of Junior Projects Manager is vacant. The Junior Projects Manager will report directly to the Projects Manager and forms part of the Office of the Chief Operations Officer Division. The position is based at GEMS Head Office in Pretoria.
The total remuneration package will be R674 894 per annum, based on the Scheme's Remuneration Policy.
 
The closing date for applications will be Wednesday, 25 March 2026.
 
Duties & Responsibilities
The Junior Projects Manager will be required to support the Projects Manager through the implementation of the following Key Performance Areas (KPAs):

• Manage assigned small projects end-to-end under the guidance of the Project Manager
• Develop project plans, schedules, and task lists for assigned projects
• Provide support to the project manager in the initiation, planning, execution, monitoring, and closure of larger projects
• Track project progress and escalate risks, issues, and deviations timeously
• Management of project costs for assigned projects and/or support the Project Manager where applicable
• Management of project schedule for assigned projects and/or support the Project Manager
• Management of project scope (planned & baselined)
• Review quality (consistency and accuracy) of project documents
• Stakeholder Analysis and Management
• Management and Maintenance of PMP Logs (all logs as per PMP)
• Identification and achievement of the minimum business benefit identified for projects assigned
• Definition of Victory (DOV) defined for the assigned project and integrated into the PMP
• Critical Success Factors (CFS) defined for the assigned project and integrated into the PMP
• Schedule and conduct monthly Steering Committee Meetings for assigned projects
• Manage and maintain an up-to-date project management repository site
• Prepare project status reports, dashboards, and presentations for project meetings and Committee meetings in collaboration with the Project Manager
• Track project milestones, budgets, and benefits realisation and ensure accurate status reporting
• Validating purchase order/s or requirement information
• Capturing data and updates in relevant systems
• Requesting quotes or information from vendors and partners
• Coordination of the Scheme Year-End Implementation Process
• Supporting the Year-End Implementation activities, including testing activities
• Managing PMO mailbox to ensure correspondence is disseminated to the divisions and to the Service Provider Networks
• Travel Arrangements and logistics for the PMO team

 
Desired Experience & Qualification

• Minimum: 3-year Degree / Diploma (NQF Level 6) in Project Management, Business Management, Operations Management, or related field
• Project Management certification (CAPM, or equivalent) will be an advantage
• Project Management methodologies (Agile foundations, Scrum, DSDM, Prince2)
• 1–3 years’ experience in a project coordination or junior project management role
• Exposure to structured project management methodologies (agile, hybrid, Prince2, waterfall)
• Experience supporting multiple projects concurrently is essential
• Proficiency in MS Office (Excel, Word, PowerPoint, MS Project, SharePoint and any other project management tools)
• Strong organisational and documentation skills
• Excellent administrative, planning and organizing skills
• Ability to work in a structured and regulated environment
• Willingness to learn and grow within the PMO
• Interpersonal skills with excellent written and verbal communication skills
• Resilient, self-motivated and pro-active (self-starter)
• Have the ability to work well as part of a team
• Knowledge of the South African medical scheme industry (advantageous)

 
 
Package & Remuneration
The total remuneration package will be R674 894 per annum, based on the Scheme's Remuneration Policy
 
Interested?

• Should you be interested, please apply for the position by emailing your CV to jobs@gems.gov.za
• The closing date for applications is 25 March 2026. Should you not hear from us by 31 May 2026, please consider your application unsuccessful.
• GEMS employs people with the highest level of integrity – submission to the appropriate pre-employment assessment is obligatory to be considered for the position.
• Please note that the information provided on the application for the position may be shared with a third party for vetting purposes and will be stored by GEMS for a period of five years. ***
• Kindly note that information is required for Recruitment and Selection 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 purposes.
• 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 the GEMS Employment Equity Plan.
• An internal employee must be in their current role for at 12 months before they will be considered for other vacancies within the Scheme.
• GEMS reserves the right not to proceed with an appointment.
• 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.

 
PLEASE APPLY HERE

​BUSINESS PROCESS ANALYST

• Pretoria
• Permanent
• Full Time
• EE/AA, Non EE/AA

Introduction
The position of Business Process Analyst is vacant. The Business Process Analyst will report directly to the Business Process Manager and forms part of the Office of the Chief Operations Officer Division. The position is based at GEMS Head Office in Pretoria.
The total remuneration package will be R641 679 – R802 027 per annum, based on the Scheme's Remuneration Policy.
 
The closing date for applications will be Wednesday, 25 March 2026.
 
Duties & Responsibilities
The Business Process Analyst will be required to provide support to the Business Process Manager through the implementation of the following Key Performance Areas (KPAs):

• Process Mapping & Documentation: Facilitate process mapping sessions and document “As-Is” and “To-Be” processes using standard BPM methodologies and tools. Ensure detailed, accurate, and maintainable process artifacts.
• Business Requirements Gathering: Engage stakeholders to collect, validate, and document business requirements that will inform process optimisation or system enhancements.
• Process Analysis & Optimisation: Analyse process performance, identify inefficiencies or gaps, and propose data-driven improvement recommendations aligned with strategic and operational goals.
• Support Process Standardisation & Quality: Ensure consistent application of process standards and contribute to quality assurance by validating that process improvements follow BPM best practices and governance.
• System Integration Awareness: Understand how business processes interact with ICT systems. Work collaboratively with ICT and business teams to ensure that process improvements are technically feasible and aligned to system capabilities.
• Transformation & Change Enablement: Support the transition from the current (“As-Is”) to the future (“To-Be”) operating model by providing process insights, documentation, and change readiness support across affected areas.
• Governance, Compliance & Framework Alignment: Ensure all process work aligns to the Business Optimisation Office’s BPM framework, governance standards, and audit/compliance requirements, track adherence (process audits) and escalate gaps.

 
Desired Experience & Qualification

• Degree/Professional qualifications at NQF Level 6 in Information Technology, Business Management or Analysis or similar.
• Formal qualification in Business Analysis.
• 5–6 years of experience in business process analysis, business process improvement, systems analysis, or related roles.
• Proven experience in documenting and analysing business processes using BPMN or other standard notations.
• Proven experience in maintaining business process documentation and repositories.
• Proven experience in collecting and analysing business requirements, translating them into optimized workflows.

 
Package & Remuneration
The total remuneration package will be R641 679 – R802 027 per annum, based on the Scheme's Remuneration Policy.
 
Interested?

• Should you be interested, please apply for the position by emailing your CV to jobs@gems.gov.za
• The closing date for applications is 25 March 2026. Should you not hear from us by 31 May 2026, please consider your application unsuccessful.
• GEMS employs people with the highest level of integrity – submission to the appropriate pre-employment assessment is obligatory to be considered for the position.
• Please note that the information provided on the application for the position may be shared with a third party for vetting purposes and will be stored by GEMS for a period of five years. ***
• Kindly note that information is required for Recruitment and Selection 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 purposes.
• 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 the GEMS Employment Equity Plan.
• An internal employee must be in their current role for at 12 months before they will be considered for other vacancies within the Scheme.
• GEMS reserves the right not to proceed with an appointment.
• 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.

 
PLEASE APPLY HERE