Health Claims Specialist
4 months ago
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**:
**Health Claims Specialist**
The Kaelo Health 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** (not limited to) Level 4 and 5 process elements
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 Xelus members, brokers and franchises
Ongoing feedback to clients
Ad hoc functions as required by Management
**Qualifications**:
**SPECIAL REQUIREMENTS**
Communication skills
Analytical ability
Timer management
Team work
Customer focus
Ability to adapt to an ever changing environment
Cope well under pressure
**PERSON DETAILS: WORK EXPERIENCE**
**REQUIRED**
Insurance industry experience
**PREFERRED**
Health Insurance industry
**EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY**
**REQUIRED**
Grade 12 - Matric
RE 5
Accreditation would be advantageous (a minimum of 120 credits)
**PREFERRED**
Accreditation would be advantageous (a minimum of 120 credits)
**TECHNICAL SKILLS OR KNOWLEDGE**
**REQUIRED**
Computer literate, including Microsoft Access
**PREFERRED**
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
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