Education & Experience: Nursing qualification (Diploma/Degree) with SANC registration (essential). Experience in pre-authorisation, case management, and clinical auditing within a managed healthcare/medical scheme environment (essential). Technical proficiency in managed healthcare systems, case management modules, and claims processing. Previous training, coaching, or mentoring experience. Supervisory/leadership background in clinical risk management (advantageous). Knowledge & Skills: Strong knowledge of ICD-10, CPT-4 coding, PMB legislation, tariffs, and scheme rules. Ability to identify non-chargeable and overcharged items in hospital accounts. Knowledge of adult learning principles and training methodologies (advantageous). Key Responsibilities Team Leadership: Mentor and support staff, oversee workloads and SLA compliance, ensure quality standards, and deliver performance reports. Training Coordination: Design and deliver training programmes, conduct assessments, identify development needs, and align content with regulatory/industry changes. Clinical Governance & Systems: Handle complex clinical queries, ensure compliance in reconciliations, support data analysis and cost containment, and participate in system testing. Process Improvement & Communication: Update SOPs and processes, drive operational efficiency, maintain stakeholder relationships, and contribute to strategic initiatives.