Job Summary
- Type: full-time
- Location: Harare
- Category: Healthcare Administration
- Closing Date: 2026-08-23
Key Responsibilities
- Adjudicate medical claims against AHFOZ and non-AHFOZ tariffs with accuracy and consistency.
- Maintain and update the Drug Master File in line with current pricing and formulary changes.
- Liaise with the Medical Services Provider Network on claims-related queries and provider account matters.
- Apply claims and benefits accounting principles correctly across member accounts.
- Apply waiting period rules accurately to new and existing membership claims.
- Verify that all claims payments are fully justified before approval, safeguarding the Society against irregular or fraudulent payments.
- Report directly to, and support, the Principal Officer, GKMAS, on claims administration matters.
Requirements
- Must be semi-retired or retired, with a proven track record in medical aid claims administration.
- Must hold a valid Class 4 Driver’s Licence.
- A veteran of medical claims tariffs, with sound working knowledge of both AHFOZ and non-AHFOZ tariff structures.
- Demonstrated experience in Drug Master File management.
- Strong working knowledge of the Medical Services Provider Network and provider relationships.
- Competence in claims and benefits accounting.
- Sound understanding of waiting periods and their correct application to claims.
- A meticulous eye for ensuring all claims payments are justified, accurate, and compliant before disbursement
How to Apply
Frequently Asked Questions
What qualifications or certifications are typically required for a Claims Clerk/Adjudicator role in Zimbabwe’s medical aid sector?
A minimum of a National Diploma or Bachelor’s degree in Health Sciences, Administration, Business Management, or related fields is commonly required. Relevant short courses in medical coding (e.g., ICD-10-CM), claims processing, or healthcare insurance offered by institutions like ZIMRA, ZIMCHE, or private providers such as the Institute of Commercial Management (ICM) are highly valued. Some employers may accept equivalent experience plus on-the-job training, especially if candidates demonstrate familiarity with Zimbabwe’s National Health Insurance Scheme (NHIS) framework.
What does a typical day look like for a Claims Clerk/Adjudicator at a medical aid society in Zimbabwe?
Daily tasks include reviewing and verifying submitted medical claims against policy terms, checking for completeness and authenticity of supporting documents (e.g., hospital invoices, doctor’s notes), and processing payments or rejections within statutory timelines set by the Medical Aid Council of Zimbabwe (MACZ). Clerks also liaise with healthcare providers, members, and internal departments via phone, email, or in-person — often using locally adapted systems like Medisys or custom-built platforms compliant with MACZ reporting requirements.
How does workplace culture and professional expectations differ for this role in Zimbabwe compared to other countries?
Zimbabwean healthcare administration places strong emphasis on interpersonal communication, patience, and cultural sensitivity — especially when explaining claim outcomes to members who may have limited health literacy or face financial constraints. Punctuality, respect for hierarchy, and adherence to formal documentation standards (including bilingual correspondence in English and local languages where appropriate) are expected, and dress codes tend to be smart-casual or business attire in most urban offices.
What realistic career progression paths exist for a Claims Clerk/Adjudicator in Zimbabwe’s medical aid industry?
With 2–4 years’ experience and demonstrated accuracy, staff often progress to Senior Claims Adjudicator or Team Leader roles, then to Claims Manager or Compliance Officer positions overseeing MACZ regulatory adherence. Further growth may include transitioning into underwriting, member services management, or quality assurance — particularly with additional certifications like the CII’s Certificate in Insurance or MACZ-endorsed continuing professional development (CPD) programmes.
What benefits can I realistically expect in this role, and how do they align with Zimbabwean labour standards?
Standard benefits include 30 days’ annual leave, sick leave per the Labour Act (Chapter 28:01), and full medical aid coverage for the employee (and sometimes dependants) through the employer’s scheme. Most reputable medical aid societies also contribute to the National Social Security Authority (NSSA) pension fund and may offer performance-based bonuses or study support for relevant professional qualifications approved by MACZ.