Clinical Risk Consultant - Oneplan Health Insurance

Location: Johannesburg, Gauteng

Department: Health Insurance Claims

Reporting to: Claims Manager About Oneplan

Oneplan is one of South Africa's leading health insurance providers, committed to making quality healthcare more accessible and affordable. We are looking for a passionate and clinically skilled professional to join our Health Insurance team as a Clinical Risk Consultant.

Purpose of the Role

The Clinical Risk Consultant is responsible for assessing clinical risk through hospital authorisations, underwriting, case management, and claims evaluation. The role supports healthcare providers, policyholders, and internal stakeholders by ensuring clinical decisions align with policy rules, clinical protocols, and regulatory requirements.

This position plays a critical role in delivering exceptional client experiences while managing risk and ensuring appropriate healthcare utilisation. ...