Gap Claims Operations Team Leader at Kaelo

Durban, KwaZulu-Natal, South Africa -

Full Time

Start Date

Immediate

Expiry Date

28 Dec, 25

Salary

0.0

Posted On

29 Sep, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Communication Skills, Analytical Ability, Time Management, Customer Focus, Team Management, Leadership, Problem Solving Skills, Decision Making, Planning and Organisation, Resilience, Adaptability, Financial Acumen, Growth Mindset, Quality Assurance, Claims Knowledge, Coaching

Industry

Insurance

Description

Company Description 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 The Gap Claims Team Leader manages both the authorisation 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. 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 Claims Manager and Claims Operations Executive. KEY OUTCOMES (not limited to) Level 4 and 5 process elements 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 on a daily basis 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 Claims experience Team management and leadership 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 Gap Claims knowledge PREFERRED Additional Information Personal Attributes Accountability Action orientated Collaborative Communication Business writing skills Manages complexity Problem solving skills Decision Growth and development mind-set Financial acumen Planning and organisation Resilient and adaptive Self-development Purpose driven Significance and values orientate

Responsibilities

The Gap Claims Team Leader manages the authorisation of claims and ensures exceptional customer service. They are responsible for monitoring team performance, resolving escalated queries, and contributing to continuous improvement in claims processing.