Gap Claims Specialist

Company Description
About 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 Description
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 claims 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.
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
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 including 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 oriented


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