Gap Claims Specialist

Company DescriptionAbout KaeloKaelo 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 – product offerings include Medical Insurance, Medical Aid, Gap Insurance, Kaelo Money and employee assistance programmes.Job DescriptionThe 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 OutcomesThe 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.QualificationsWork ExperienceRequiredInsurance Industry Experience.PreferredHealth Insurance Industry Experience.Education, Qualifications and Accreditation with Professional BodyRequiredMatric.FAIS / RE5.PreferredFAIS / RE5 Accreditation with minimum 120 credits.Technical Skills or KnowledgeRequiredComputer Literate incl. Microsoft Access.Additional InformationAccountability.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.
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