Operational excellence –
The unsung hero of medical aid success
Angela Blackburn, Chief Operating Officer at Medshield Medical Scheme
25 September 2025
JOHANNESBURG - When your medical aid works seamlessly, you rarely think about what happens behind the scenes. Your claims are paid, queries are answered, and hospital authorisations arrive on time. But when something goes wrong – when a payment is delayed, a call goes unanswered, or a benefit is unclear – the impact on trust is immediate and lasting.
The difference between these two experiences often comes down to one function: Operations.
At Medshield, Operations is far more than an administrative necessity. It is the backbone of service delivery, the guardian of member trust, and the driver of our ability to keep the promise we make to every member to be a Partner for Life. From the first moment a member joins to the final processing of a claim, our Operations team ensures that every step is seamless, accurate, and member-focused.
Member-centred service in a digital age
The Operations team manages every part of the service journey: onboarding new members, collecting contributions, resolving queries and escalations, managing provider networks, and overseeing the entire claims process. This breadth of responsibility means that our performance directly impacts both member satisfaction and the Scheme's reputation.
Our approach combines efficiency with empathy. We integrate innovative tools such as virtual consultations and digital self-service channels, while ensuring that personal, human support remains available to every member. Mutual respect, accountability, and transparency guide all interactions with members and stakeholders, reinforcing trust at every step.
Members today expect quick, convenient access to services, whether through a smartphone app or a secure chat platform. Medshield has responded with multiple self-service options, including the Medshield Member Mobile App, WhatsApp, and our Interactive Voice Response (IVR) system. These allow members to check benefits, submit claims, request hospital authorisations, and access membership details 24/7.
However, healthcare is deeply personal, and not every query can be resolved online. That's why we have retained our walk-in centre at head office and four regional offices, where members and brokers can receive personalised, face-to-face assistance. Our contact centre also offers real-time, empathetic interactions with trained agents. This balance between digital efficiency and human warmth is a cornerstone of our Partner for Life promise.
Accuracy and trust in every transaction
Claims processing is at the heart of a medical scheme's offering, and for members, speed and accuracy matter. At Medshield, we process three claim payment runs every week. Our advanced systems streamline workflows, ensuring prompt adjudication and payment. We also maintain an AA- with positive outlook financial rating from Global Credit Ratings, underscoring our reliability in settling claims.
To minimise rejections, we work closely with providers to ensure claims align with Medshield tariffs and proactively educate members about their plan benefits and documentation requirements. This education happens through our app, contact centre, and regular communications, including quarterly newsletters, reducing avoidable errors and delays.
Operational excellence isn't just an aspiration – it's something we measure and hold ourselves accountable to. Medshield's ISO9001-2015 accreditation reflects our commitment to a world-class Quality Management System (QMS) that ensures consistent standards across all member services. This accreditation drives continuous improvement in everything from claims processing to member support, aligning us with international benchmarks for efficiency, reliability, and transparency. For our members, it means they can count on us to deliver consistent, high-quality service every time.
Why operations matter more than ever
Healthcare is a fast-moving sector, shaped by technology, regulation, and shifting member expectations. We see enormous potential in the greater use of artificial intelligence for claims processing and predictive analytics to anticipate member needs. These tools can help identify trends, flag anomalies, and personalise services – while freeing up staff to focus on complex cases that require human judgment.
The expansion of our Digital Healthcare Ecosystem will also make virtual care and telehealth more accessible, particularly for members in remote areas. At the same time, we're building stronger partnerships with innovative providers to deliver a blend of convenience, quality, and clinical excellence.
Operations might not be visible to members in the same way as clinical care, but their impact is profound. They influence whether members experience healthcare as a seamless, reassuring journey or a frustrating series of obstacles. In a competitive market, operational strength can be a key differentiator – turning satisfied members into long-term advocates. Without it, the heart of our mission to provide affordable, accessible, and trusted healthcare cannot function effectively.
Being a Partner for Life is about more than covering medical expenses. It's about keeping our processes agile and reliable, so that when members need us to approve a procedure, pay a claim, or answer a question, we respond quickly, accurately, and with empathy. Our commitment to operational excellence is not a behind-the-scenes technicality. It is the foundation of our relationship with members, the framework that supports our service delivery, and the reason we can meet our promise of quality care in an ever-changing healthcare environment.
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