Health Claims Specialist
2 weeks 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
-
Claims Specialist: Accident
2 weeks ago
Johannesburg, South Africa Santam Full timeWhat will you do? This career opportunity is available at SHA Risk Specialists a division of Santam for a Claims Specialist: Accident & Health, who will be based in Johannesburg: Illovo. What will make you successful in this role? Claims Portfolio Attend to all aspects related to a portfolio of claims e.g. new claims, current files, diary, mail,...
-
Health Claims Administrator
2 weeks 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...
-
Health Claims Administrator
7 days ago
Johannesburg, South Africa Kaelo Full timeCompany 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...
-
Claims Specialist
2 weeks ago
Johannesburg, South Africa HumanTouch Recruitment Full time**Claims Specialist** An insurance company has a new position available for a Claims Specialist: Liability who will be based in Johannesburg - Illovo. **Minimum Requirements** - Experience 2 years in Liability / PI claims (handling at an insurer or litigation at an attorney firm) - Matric - Legal qualification required **Duties** Claims Practice...
-
Motor Claims Specialist
2 weeks ago
Johannesburg, South Africa Ultra Personnel Full timeMatric (Grade 12) is essential FETC (Further Education & Training Certificate) in Short Term Insurance NQF 4 (150 credits) Higher Certificate in Short Term Insurance : NQF 5 or higher is highly advantageous Successfully passed RE 5 Class of Business certification (Personal Lines & Commercial Lines) Highly advantageous Must be compliant with FAIS Fit and...
-
Claims Specialist: Casualty Claims
2 weeks ago
Johannesburg, South Africa Santam Full timeWhat will you do? This career opportunity is available at SHA Risk Specialists, a division of Santam for a Claims Specialist: Casualty Claims, who will be based in Johannesburg, Illovo. What will make you successful in this role? Claims Practice Management Attend and manage all aspects related to a portfolio of specialist claims such as claims...
-
Medical Claims Specialist
2 days ago
Johannesburg, Gauteng, South Africa Qetello Holdings Full timeAs a Medical Claims Specialist with Qetello Holdings in Johannesburg, you will play a crucial role in assisting our client, a leading claims administrator in the area, with Private and medical aid claims.Key ResponsibilitiesImplement credit control procedures for specialist doctors and Allied Professionals in accordance with our credit control/debt...
-
Motor Claims Specialist
2 weeks ago
Johannesburg, South Africa CIB PTY (LTD) Full time**Main purpose of the role**: The main purpose of the Claims Specialist's role is to validate and administer a client's motor claim following a fortuitous event. In accordance with Standard Operating Procedures, claims guidelines, the specialist own mandate, and the client's policy schedule, the specialist will make a claims settlement...
-
Claims Assessment Specialist
13 hours ago
Johannesburg, Gauteng, South Africa Zensar Technologies Full timeWe are looking for a skilled Claims Assessment Specialist to join our team at Zensar Technologies. As a Claims Assessor, you will provide specialist advice and support in the generation and provision of reliable claims assessment activities.The ideal candidate will have a strong understanding of insurance products and services, as well as the ability to...
-
Motor Claims Specialist
5 days ago
Johannesburg, South Africa HR CAPITAL RECRUITMENT PTY Ltd Full time**MOTOR CLAIMS SPECIALIST** required for a well-established insurance company based on the East Rand to validate and administrate motor claims in accordance with Standard Operating Procedure, claims guidelines, the specialist’s own mandate, and the client’s policy schedule. **Minimum Requirements**: - Matric (Grade 12) - essential - FETC (Further...
-
Claims Specialist
2 weeks ago
Johannesburg, South Africa HR CAPITAL RECRUITMENT PTY Ltd Full time**NON-MOTOR CLAIMS SPECIALIST** required for a well-established insurance company based on the East Rand to validate and process short-term insurance claims following a fortuitous event. In accordance with Standard Operating Procedure, claims guidelines, the specialist own mandate, and the client’s policy schedule, the Claims Specialist will make a claims...
-
Binder and Outsourced Claims Specialist
4 weeks ago
Johannesburg, South Africa Ultra Personnel Full timeMatric Certificate and Regulatory Exams Further Education and Training Certificate in Short-Term Insurance NQF 4, and/ or a Higher Certificate in Short term Insurance - NQF 5 Class of Business certification (Personal Lines & Commercial Lines) Highly advantageous Must be compliant with FAIS Fit and Proper requirements with track-record of working...
-
Specialist Claims Advisor
2 weeks ago
Johannesburg, South Africa Marsh Full time**Specialist Claims Advisor**: **What can you expect?** Marsh is a global leader in **insurance broking** and innovative risk management solutions. We help clients quantify and manage risk and help them unlock new growth opportunities. Having an established presence in more than 130 countries worldwide, national and international collaboration and...
-
Claims Specialist
2 weeks ago
Johannesburg, Gauteng, South Africa Santam Insurance Full timeJob title : Claims Specialist : Technical Trainer JHB (JG7)Job Location : Gauteng, JohannesburgDeadline : March 07, 2025Quick Recommended LinksJobs by Location Job by industries KEY RESPONSIBILITIESProvide ongoing Technical and Operational training (technical, claims procedure for existing staff and new appointments) as required. Ensure compliance to...
-
Workplace Health and Safety Specialist
2 weeks ago
Johannesburg, South Africa South African Bankers Services Company Pty Ltd Full time**Job Description**: The purpose of the Workplace Health and Safety Specialist is to ensure compliance of the Occupational Health and Safety (OHS) Act, Policies, Regulations and other relevant legislation, keeping all company records as regulated by the OHS Act and sets and directs the Workplace Health Programme. **You will engage with the following...
-
Join Green Pill Health As a Specialist Physician
2 weeks ago
Johannesburg, South Africa Green Pill Health Full timeCompany Overview: Green Pill Health is a leading health and wellness platform and app based in South Africa. Our platform connects individuals with qualified healthcare professionals, including specialist physicians, offering a convenient and accessible way to access specialized medical care. We are committed to improving the health and well-being of our...
-
Claims Specialist
2 weeks ago
Johannesburg, South Africa Antal Full time**Claims Specialist **(non-motor liability)** - JHB** We are looking to connect with Claims professionals with a minimum of 1 - 5 year’s non-motor liability experience. Our client is a leading insurance company based in Johannesburg and is in need of a Claims Specialist who will be responsible for attending and managing all aspects related to a portfolio...
-
Claims Specialist Johannesburg
2 days ago
Johannesburg, Gauteng, South Africa Tower Group (Pty) Ltd Full timeJob SummaryAt Tower Group (Pty) Ltd, we seek a skilled Claims Specialist to join our team in Johannesburg. As a key member of our organization, you will be responsible for resolving claims and providing exceptional customer service.About the RoleThis is a challenging opportunity for an experienced professional to utilize their technical skills and...
-
Insurance Claim Specialist
9 hours ago
Johannesburg, Gauteng, South Africa Energy at Work Full timeClaims Conqueror Job SummaryWe are looking for an Insurance Claim Specialist to join our team at Energy at Work. This is an exciting opportunity for a skilled and enthusiastic individual who thrives in the world of claims management.About the Role:As a Claims Conqueror, you will register claims with flair, negotiate effectively, finalize claims smoothly,...
-
Senior Non-motor Claims Specialist
4 weeks ago
Johannesburg, South Africa Ultra Personnel Full timeMatric Certificate and Regulatory Exams Further Education and Training Certificate in Short-Term Insurance NQF 4, and / or a Higher Certificate in Short term Insurance - NQF 5 Class of Business certification (Personal Lines & Commercial Lines) Highly advantageous Must be compliant with FAIS Fit and Proper requirements with track-record of working...