Nelia Roos

Dedicated healthcare leader with over 22 years of progressive experience across managed healthcare, hospital benefits, pre-authorisation, case management, and disease risk management. Currently serving as Head of Department | Managed Healthcare at PPSHA, where I drive clinical and operational excellence, process optimisation, and high-quality service delivery.

Previously Functional

Head | Hospital Benefits at Discovery Health (2021-2025), leading system improvements and benefit implementation. A Registered Nurse (B.Cur) with a strong commercial foundation through B.Com and B.Com Hons in Economics (UNISA). Recognised for a proven track record in operational analysis, process improvement, stakeholder management, and delivering innovative solutions that enhance efficiency and service quality in the managed healthcare environment.

HOD | Managed Healthcare - PPSHA

(2025-10)

• Oversee pre-authorisation, case management, and disease risk management functions while ensuring operational efficiency and audit readiness.
• Drive process optimisation, team performance, and alignment with organisational objectives.
• Manage clinical and operational risks and maintain strong internal and external stakeholder relationships.

Functional Head | Hospital Benefits - Discovery Health

(2021 - 2025)

• Led a team of clinical analysts and acted as subject matter expert for hospital benefits.
• Analysed trends, developed business cases, and supported system and process improvements.
• Contributed to end-to-end project delivery, including requirements, testing, defect resolution, and benefit updates.
• Managed stakeholder communications and supported training initiatives while maintaining audit compliance.

Clinical Analyst - Discovery Health

(2012 - 2021)

• Performed clinical and operational analysis, identified trends, and implemented process improvements.
• Collaborated with technical and business teams on system enhancements and benefit management.
• Supported data accuracy, training materials, and overall operational effectiveness.

Pre-Auth Team Leader

(2007 - 2012)

Operational Analyst

(2005 - 2007)

Medical Review Consultant

(2003 - 2004)

Pre-Auth Consultant

(2001 - 2003)

B.Com Hons - Economics - UNISA (2017 - 2019)

B.Com - Economics - UNISA (2013 - 2016)

B.Cur - Nursing - University of Johannesburg (1994 - 1997)