Health Claims Specialist

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 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



  • Johannesburg, South Africa Santam Full time

    What 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,...


  • 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...


  • 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...

  • 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...


  • Johannesburg, South Africa Ultra Personnel Full time

    Matric (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

    6 days ago


    Johannesburg, Gauteng, South Africa WatersEdge Solutions Full time

    Claims SpecialistWe are seeking a dedicated and detail-oriented Claims Specialist to join our growing team. This role is essential in delivering a seamless, client-centric claims experience within the funeral and insurance space. The successful candidate will be responsible for the end-to-end validation and finalisation of registered claims, ensuring that...

  • Claims Specialist

    5 days ago


    Johannesburg, Gauteng, South Africa WatersEdge Solutions Full time

    Claims SpecialistWe are seeking a dedicated and detail-oriented Claims Specialist to join our growing team. This role is essential in delivering a seamless, client-centric claims experience within the funeral and insurance space. The successful candidate will be responsible for the end-to-end validation and finalisation of registered claims, ensuring that...


  • Johannesburg, South Africa Santam Full time

    What 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...

  • Claims Specialist

    2 days ago


    Johannesburg, Gauteng, South Africa WatersEdge Solutions Full time

    Claims SpecialistWe are seeking a dedicated and detail-oriented Claims Specialist to join our growing team. This role is essential in delivering a seamless, client-centric claims experience within the funeral and insurance space. The successful candidate will be responsible for the end-to-end validation and finalisation of registered claims, ensuring that...

  • Claims Specialist

    5 days ago


    Johannesburg, Gauteng, South Africa WatersEdge Solutions Full time

    At WatersEdge Solutions, we are seeking a skilled Claims Specialist to deliver exceptional client service and validate claims efficiently.The successful candidate will be responsible for the end-to-end validation of registered claims, ensuring accuracy and compliance with policy terms.Key Responsibilities:Validate all registered claims, ensuring accuracy and...


  • Johannesburg, Gauteng, South Africa WTW Full time

    Job Description:WTW is seeking a Claims Operations Specialist to assist in managing and processing insurance claims for corporate clients. The ideal candidate will have a strong understanding of insurance claims processes and policy wordings, excellent communication and negotiation skills, and analytical problem-solving abilities.Main Responsibilities:-...


  • 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...


  • Johannesburg, Gauteng, South Africa Manpower Group Sa (Pty) Ltd Full time

    The main purpose of the Claims Specialist's role is to validate and administrate a client's motor claim following a fortuitous event.In accordance with Standard Operating Procedure, claims guidelines, the specialist's own mandate, and the client's policy schedule, the specialist will make a claims settlement determination.Requirements:Matric (Grade 12) -...


  • Johannesburg, Gauteng, South Africa University of Fort Hare Full time

    Annually Cost To Company (Market related)The main purpose of the Claims Specialist's role is to validate and administrate a client's motor claim following a fortuitous event. In accordance with Standard Operating Procedure, claims guidelines, the specialist own mandate, and the client's policy schedule, the specialist will make a claims settlement...


  • Johannesburg, Gauteng, South Africa Telesure Investment Holdings Full time

    Job Title: Insurance Claims SpecialistAt Telesure Investment Holdings, we are seeking an experienced Insurance Claims Specialist to join our team. The successful candidate will be responsible for validating claims using all available resources. This role requires a strong understanding of business insurance and commercial / STI insurance experience is...


  • Johannesburg, Gauteng, South Africa Ajtechnicaldr Full time

    Job SummaryRoyal Air Force (RAF) is seeking a skilled Senior Claims Specialist to join their team. This role involves pre-assessing prospective claims, ensuring compliance with defined processes and rules, and communicating assessment outcomes to claimants.About the RoleThis is a full-time position based in Johannesburg, South Africa. The successful...


  • Johannesburg, South Africa Santam Full time

    What 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 registration,...

  • Claims Specialist

    2 weeks ago


    Johannesburg, South Africa Santam Full time

    MAIN PURPOSE OF JOB This career opportunity is available at Mirabilis a division of Santam for the Claims Specialist, who will be based in Johannesburg. The main purpose of the job is to administer claims which include accurate claim assessment, assessor appointment, corresponding with brokers and service providers and attending to claim documentation. It...


  • Johannesburg, Gauteng, South Africa Hollard Full time

    Job OverviewThe Motor Assessor-JHB role is an exciting new opportunity in our Insure Operations, specifically in the Motor Claims area. We are seeking a skilled professional to join our team as a Motor Claims Specialist in Johannesburg.


  • 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...