By virtue of section 29(1)(j) of the Medical Schemes Act 31 of 1998, the Board of Trustees (BoT) is obliged to establish a Complaint/ Dispute Adjudication Committee. Rule 19 of the Scheme Rules pertains to complaints and disputes and sets out the procedural aspects for lodging a complaint. It also sets out the establishment and composition of the disputes committee. The responsibilities will include the following, amongst others:

  • To oversee the member quality experience as far as disputes between a member and the Scheme, and any appeal against any decision, outcome, and/or result. Ensure that the entire process of member disputes and to ensure that all disputes are investigated and resolved satisfactorily and in accordance with the Scheme Rules, MSA, and all other applicable law, and to put in place recommendations which will prevent similar issues recurring in future.
  • Oversee the investigation performed by the Scheme staff and shall moderate and/or review any processes and decisions reached or implemented.
  • Independently considering and presiding over any dispute that members may refer to it for
  • Handling all complaints and or disputes with the highest integrity, honesty, and
  • Properly investigate every complaint and/or dispute referred to it.
  • Resolving difficult and unique problematic
  • Provide a ruling within 10 days of the Dispute Committee meeting held.
  • Identifying recurring issues and suggesting ways to limit their occurrence. Ensuring a consistent standard in dealing with
  • Ensuring a healthy relationship is maintained with the Council for Medical
  • Ad-hoc functions that the BOT may delegate to the

  • Medical Degree (MBChB qualification) with experience in the Medical Scheme sector

  • Medical Officer of not less than 10 years standing and practising as such
  • Willingness to work with various stakeholders and statutory bodies

Desired Skills:

  • medical degree

Desired Qualification Level:

  • Degree

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