Gap Claims Specialist
3 weeks ago
Company Description
Kaelo provides **essential healthcare solutions** ensuring the **physical and psychosocial wellbeing** of **all South Africans** towards **lasting social change**.
**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 claim 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
- 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 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 incl. Microsoft Access
Additional Information
- Action orientated
- Collaborative
- Communication
- Business writing skills
- Manages complexity
- Problem solving skills
- Encourages engagement
- Efficient and Effective mind-set
- Planning and organisation
- Resilient and adaptive
- Self-development
- Systems thinking and connecting ability
- Purpose driven
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