Role Purpose


We are seeking a highly skilled and experienced Quality Assurance Manager to lead our Quality Assurance function and ensure operational excellence across our medical insurance business. This senior leadership role is responsible for establishing and maintaining robust quality assurance processes, standards, and practices, as well as developing and implementing quality frameworks, strategies, and processes that drive continuous improvement, enhance customer satisfaction, and ensure compliance with regulatory requirements.


Main Responsibilities

Strategy & Governance


Develop and implement the QA strategy, frameworks, and initiatives to drive continuous improvement and operational efficiency.
Align QA strategies with the company’s strategic goals in collaboration with senior management.
Monitor industry trends, regulatory changes, and emerging technologies to ensure the company’s QA standards remain competitive and compliant.
Maintain effective relationships with external stakeholders, including regulators and accreditation agencies, to stay informed and ensure compliance.
.Serve as the company’s ISO Management Representative, ensuring full compliance with ISO standards and managing related audits.


Operational Quality Assurance


Establish and maintain quality standards, guidelines, and protocols for all business functions, particularly claims processing and systems performance.
Conduct regular operational audits across departments to assess compliance, accuracy, efficiency, and effectiveness.
Analyse audit findings and performance data to identify trends, root causes, and opportunities for improvement.
Develop and oversee corrective action plans to address identified issues and ensure timely resolution.
Lead the design and execution of User Acceptance Testing (UAT) protocols for new systems, upgrades, and automation projects.
Ensure operational processes enhance customer satisfaction and meet SLA commitments.
Monitor the quality of services provided by third-party vendors to ensure contractual obligations and service standards are met.


Claims & Systems QA


Oversee quality control processes for claims assessment, adjudication, payment, and communication.
Perform regular claims audits to ensure accuracy, fairness, and compliance with policy terms.
Collaborate with IT, Operations, and Claims teams to ensure system controls and data integrity safeguards are embedded in all business-critical applications.


ISO Certification & Compliance


Coordinate all internal and external ISO audits, ensuring readiness and adherence to ISO 9001 standards.
Maintain the Quality Management System (QMS) documentation and oversee ISO-related training for staff.


Reporting & Dashboarding


Provide timely, accurate, and insightful reports to the CEO and leadership team on QA metrics, audit findings, and improvement initiatives.
Use data-driven insights to guide decision-making and continuous improvement initiatives.


Leadership, People Management & Culture


Lead, mentor, and develop the QA team, setting clear performance expectations and conducting regular reviews.
Foster a culture of accountability, customer focus, and continuous improvement.
Support change management initiatives, helping teams adapt to new processes and systems.
Encourage collaboration across departments to achieve quality objectives.


Key Competencies


Quality Management Systems (QMS) & ISO Standards
Claims Quality Assurance & Auditing
Systems Testing & User Acceptance Testing (UAT)
Data Analysis
 Project Management in QA Initiatives


Academic & Professional Qualifications


Bachelor’s degree in Business Administration, Quality Management, Healthcare Administration, or a related field.
Master’s degree preferred.
ISO Lead Auditor or Internal Auditor certification required.
Project Management certification (PMP, PRINCE2) an advantage.
Six Sigma or Certified Quality Manager qualification desirable.


Relevant Experience


The ideal candidate will have a minimum of eight (8) years’ experience in Quality Assurance within insurance, healthcare, or financial services, with at least 3 years in a leadership role with proven track record in claims QA, systems testing, ISO compliance, and project management. Experience with one of the Big Four audit firms will be considered an advantage.