Gap Claims Specialist at Kaelo

Durban, KwaZulu-Natal, South Africa -

Full Time

Start Date

Immediate

Expiry Date

04 Jun, 26

Salary

0.0

Posted On

06 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Assessment, Customer Service, Claim Processing, Risk Management, Query Resolution, Administrative Tasks, Communication, Problem Solving, Decision Making, Adaptability, Resourcefulness, Self-Awareness, Microsoft Access

Industry

Insurance

Description

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 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 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

Responsibilities

The Claims Specialist is responsible for managing the assessment of claims, focusing on accurate and efficient resolution while ensuring exceptional customer satisfaction. Key outcomes include accurate claim processing, attending to queries within agreed turnaround times, and completing daily administrative targets.