Job Description

Company Description

About Kaelo

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 Claims Specialist manages the assessment 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

Key Outcomes

The accurate and efficient processing of claims captured Ad hoc duties- support in the operation of other divisions 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 Contribute toward risk management Assist clients with queries and provide suitable query resolution Accurate completion of administrative targets on a daily basis Dealing with multiple telephonic queries from members, brokers and franchises Ongoing feedback to clients Ad hoc functions as required by Management

Qualifications

Qualifications

Work Experience

Required

Insurance Industry Experience

Preferred

Health Insurance Industry Experience

Education, Qualifications and Accreditation with Professional Body

Required

Matric FAIS / RE5

Preferred

FAIS / RE5 Accreditation with minimum 120 credits

Technical Skills or Knowledge

Required

Computer Literate incl. Microsoft Access

Additional Information

Accountability

Action orientated

Collaborative

Communication

Business writing skills

Manage complexity

Problem solving skills

Decision thinking

Encourages engagement

Resilient and adaptive

Resourceful

Demonstrates self-awareness

Purpose driven

*

Significance and values orientated