Gap Claims Specialist

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
**Personal Attributes**
- Accountability
- Action Orientated
- Collaborative
- Communication Skills
- Simple Writing Skills
- Manages Complexity
- Problem Solving Skills
- Creative Thinking
- Decision Making SKills
- Efficient and Effective Mindset
- Financial Acumen
- Planning and Organisation
- Resilient and adaptive
- Resourcesful
- Signancance and values orientated