Gap Claims Specialist

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

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

•       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