Job Description

Company Description

Kaelo provides essential healthcare solutions ensuring the physical and psychosocial wellbeing of all South Africans towards lasting social change. Kaelo meets the Healthcare needs of Corporate and Retail clients across South Africa - products offerings include Medical Insurance, Medical Aid, Gap Insurance, Kaelo Money and employee assistance programmes.

The Gap Claims Team Leader manages both the authorisation of claims and has specialised knowledge of the claims environment. There is a strong focus on accurately and efficiently resolving the claim received whilst ensuring exceptional customer service and satisfaction. The claims team leader has the responsibility of ensuring that the claims team carry out their responsibility while keeping the team motivated and efficient. The claims team leader works closely with the Claims Manager and Claims Operations Executive.


KEY OUTCOMES (not limited to) Level 4 and 5 process elements

Reporting and Managing Key Team Deliverables

Monitoring of the daily dashboard to ensure adherence to SLA

Monitoring the teams accurate and efficient processing of claims

Contribute towards continuous improvement and innovation at process and procedure level

To ensure that all claims processing and queries are attended to accurately and within the agreed turnaround time

Monitoring of daily performance statistics and workforce management

Daily claims focus and work allocation

Assist clients with escalated queries and provide suitable query resolution

Accurate completion of people management tasks on a daily basis

Ongoing feedback to clients

People and Team Management

People and team management

Ensuring participative leadership and strong communication within the team

Collaboration with all business areas

Coaching and peer to peer learning

Knowledge and Quality Management

Developing of all employees and ensuring smooth onboarding for new employees.

Review, maintenance and improvement of all processes and document management

Quality assurance and trending

Contribute toward risk management

Qualifications

SPECIAL REQUIREMENTS

Communication skills

Analytical ability

Time management

Customer focus

Ability to adapt to an ever changing environment

Cope well under pressure


PERSON DETAILS: WORK EXPERIENCE

REQUIRED

Insurance industry experience

Claims experience

Team management and leadership experience

PREFERRED

Health Insurance industry


EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY

REQUIRED

Grade 12 - Matric

RE 5

Accreditation would be advantageous (a minimum of 120 credits)

PREFERRED

Accreditation would be advantageous (a minimum of 120 credits)


TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED

Computer literate, including Microsoft Access

Gap Claims knowledge

PREFERRED

Additional Information

Personal Attributes

Accountability Action orientated Collaborative Communication Business writing skills Manages complexity Problem solving skills Decision Growth and development mind-set Financial acumen Planning and organisation Resilient and adaptive Self-development Purpose driven * Significance and values orientate