Health Claims Specialist

4 months ago


Johannesburg, South Africa Kaelo 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**:
**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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