Health and Life Claims Team Leader

Company Description

Kaelo provides **essential healthcare solutions** ensuring the **physical and psychosocial wellbeing** of **all South Africans** towards **lasting social change**.

**Job Description**:
Health and Life Claims Team Leader manages both the authorisation of claims and has specialised knowledge of the claim’s environment. There is a strong focus on accurately and efficiently resolving the claim received whilst ensuring exceptional customer service and satisfaction. The claims team leader has the responsibility of ensuring that the claims team carry out their responsibility while keeping the team motivated and efficient. The claims team leader works closely with the Health Operations Manager

**KEY OUTCOMES**

Determines claims operational strategies by conducting:

- Assessments
- Performance Review
- Capacity Planning
- Productivity Quality
- Customer service standards

Maintains and improves claims operations by monitoring system performance.

Accomplishes people objectives by recruiting, selecting, training, assigning, couching, counselling and disciplining employees.

Pre-pare claims performance report by collecting, analysing, and summarising data and trends.

**Reporting and Managing Key Team Deliverables**

Monitoring of the daily dashboard to ensure adherence to SLA.

Monitoring the teams accurate and efficient processing of claims

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.

Monitoring of daily performance statistics and workforce management

Daily claims focus and work allocation.

Assist clients with escalated queries and provide suitable query resolution.

Accurate completion of people management tasks daily

Ongoing feedback to clients

**People and Team Management**

People and team management

Ensuring participative leadership and strong communication within the team

Collaboration with all business areas

Coaching and peer to peer learning

**Knowledge and Quality Management**

Developing of all employees and ensuring smooth onboarding for new employees.

Review, maintenance and improvement of all processes and document management

Quality assurance and trending

Contribute toward risk management.

**Qualifications**:
**SPECIAL REQUIREMENTS**

Communication skills

Analytical ability

Time management

Customer focus

Ability to adapt to an ever-changing environment.

Cope well under pressure

**PERSON DETAILS: WORK EXPERIENCE**

**REQUIRED**

Insurance industry experience

2+ years claims experience.

FAIS (minimum 120 credits)

1+ years management experience

**PREFERRED**

2+ years Health Insurance Experience

2+ years Life Insurance Experience

**EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY**

**REQUIRED**

Grade 12 - Matric

**PREFERRED**

RE5 Accreditation would be advantageous.

**TECHNICAL SKILLS OR KNOWLEDGE**

**REQUIRED**

Computer literate, including Microsoft Office

MIP

Putty

Fresh Works (advantageous)

Additional Information

**Accountability**

**Action orientated**

**Communication**

**Business writing and presentation skills**

**Problem solving skills**

**Creative thinking**

**Strong relationship skills**

**Growth and development mind-set**

**Planning and organisation**

**Resilient and adaptive**

**Systems thinking and connecting ability**

**Professional and brand conscious**

Should you progress in the interview process, we may request special person information* from you. We strive to only gather this information during the offer stage and use encryption based software to protect this information.