Open to opportunities

Seth Van Heerden

@sethvanheerden

Message

Clinical Services & Scheme Liaison leader improving compliance and patient outcomes.

South Africa

Message

What I'm looking for

I’m looking to lead clinical operations and scheme liaison work where I can strengthen PMB governance, ensure regulatory and CMS compliance, resolve escalations, and improve workflows for better patient outcomes.

I’m a Clinical Services & Scheme Liaison Manager with over 15 years of experience in South Africa’s managed care and private healthcare environment. I focus on PMB management, clinical compliance, and scheme liaison—turning complex escalations into clear, actionable outcomes.

Over the past 3 years at XPEDIENT (2022–2025), I led multidisciplinary teams of 25–30 staff while managing complex PMB escalations and strengthening scheme relationships. I improved workflows and compliance, supported performance reporting and analysis, and drove operational efficiency and patient-centred results.

Earlier roles further shaped my clinical governance expertise: I served as an Auditor | Schemes & CMS Liaison (2018–2022), conducting clinical audits, resolving CMS escalations, and implementing corrective risk controls. From 2010–2017 as a PMB Specialist at Discovery Limited, I managed Chronic, HIV & Oncology PMB protocols and clinical authorisations.

Experience

Work history, roles, and key accomplishments

Clinical Scheme Liaison Manager

Xpedient

Jan 2022 - Jan 2025 (3 years)

Led multidisciplinary teams of 25–30 staff and managed complex PMB escalations to strengthen scheme relationships. Improved workflows and clinical compliance through enhanced governance and escalation resolution.

PMB Governance Clinical Compliance Scheme Liaison Escalations Clinical Auditing ICD 10 Coding CPT Coding Risk Mitigation Team Leadership performance reporting

Auditor, Schemes & CMS

Xpedient Medical Business Specialists

Jan 2018 - Jan 2022 (4 years)

Conducted clinical audits and resolved CMS escalations by implementing corrective risk controls. Coordinated scheme/CMS liaison activities to improve compliance outcomes.

Clinical Auditing Escalations Risk & Controls Scheme Management performance reporting Stakeholder Management PMB CMS Liaison Clinical Monitoring

PMB Specialist

Discovery Limited

Jan 2010 - Jan 2017 (7 years)

Managed Chronic, HIV, and Oncology PMB protocols and handled clinical authorisations. Supported clinical governance by ensuring appropriate protocol management for scheme compliance.