Health Claims Administrator

4 days ago


Randburg, Gauteng, South Africa Red Ember Recruitment (PTY) Ltd Full time
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.

Job Description
The Kaelo Health Claims Administrator is responsible for the management of all gap cover related tickets and correspondence. The responsible person captures all gap cover claims and corresponds with the membership base. This individual has knowledge of the gap claims environment. There is a strong focus on accurately and efficiently resolving the claim ticket received whilst ensuring effective communication and exceptional customer service and satisfaction.

KEY OUTCOMES
(not limited to) Level 4 and 5 process elements
  1. The accurate and efficient capturing of claims received
  2. Assist Kaelo clients with queries and provide suitable query resolution
  3. Accurate completion of administrative targets on a daily basis
  4. Dealing with multiple queries from Kaelo members and intermediaries
  5. Ongoing feedback to clients
  6. Management of all claim related mailboxes
SPECIAL REQUIREMENTS
  1. Ad hoc functions as required by management
  2. Good communication skills
  3. Analytical ability
  4. Time management
  5. Team work
  6. Customer focus
  7. Data capturing experience
Qualifications
WORK EXPERIENCE
REQUIRED
  1. Insurance industry experience
  2. 2-5 Years experience in claims handling
PREFERRED
  1. Health Insurance industry experience
EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY
REQUIRED
  1. FAIS
  2. Grade 12 – Matric
PREFERRED
  1. RE5 certificate
TECHNICAL SKILLS OR KNOWLEDGE
  1. Computer literate, including Microsoft Access and Intermediate Excel Skills.
PREFERRED
  1. Experience on MIP system
Additional Information
  1. Accountability
  2. Action orientated
  3. Collaborative
  4. Communication
  5. Business writing skills
  6. Manage complexity
  7. Problem solving skills
  8. Decision thinking
  9. Encourages engagement
  10. Resilient and adaptive
  11. Resourceful
  12. Demonstrates self-awareness
  13. Purpose driven
  14. Significance and values orientated
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