Health Escalations Agent at Kaelo

Randburg, Gauteng, South Africa -

Full Time

Start Date

Immediate

Expiry Date

09 Sep, 26

Salary

0.0

Posted On

11 Jun, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Complaint Handling, Customer Service, Investigation, Problem Solving, Written Communication, Verbal Communication, Attention To Detail, Root Cause Analysis, SLA Management, Compliance

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 Escalations Agent is responsible for handling customer complaints, queries, and escalations in a professional, timely, and customer-focused manner. Key Responsibilities Receive and manage complaints and escalations through the relevant workflow system. Investigate complaints by gathering all necessary information and supporting documents. Respond to members, providers, and other stakeholders clearly and professionally. Send first responses and ongoing updates within agreed service levels. Ensure complaints are resolved as quickly and effectively as possible. Use the correct templates and processes when communicating outcomes. Keep accurate records of all actions taken on the system. Capture the correct complaint details, categories, and outcomes for reporting purposes. Complete root cause analysis, remedial actions, and preventative actions where required. Escalate complex, regulatory, or sensitive matters to management when needed. Work closely with internal departments to obtain information and drive resolution. Maintain high standards of customer service, quality, and compliance. Support audit, reporting, and continuous improvement processes. Qualifications Required Matric Preferred RE1 Knowledge/Experience: 1-2 years’ experience in the Health Insurance industry, in complaints handling, customer service, claims, or escalations is advantageous Key Requirements Strong written and verbal communication skills Good investigation and problem-solving ability Strong attention to detail Ability to manage difficult complaints professionally Ability to work under pressure and meet deadlines Understanding of SLA-driven environments and compliance processes is beneficial Additional Information Why Join Us? This is an opportunity to play a critical role in improving healthcare quality, protecting patients, strengthening organizational integrity, and driving meaningful change. You will work alongside passionate professionals in an environment that values innovation, accountability, collaboration, and continuous improvement. If you are ready to make a measurable impact and help shape a safer, higher-quality, and more resilient healthcare organization, we encourage you to apply.

Responsibilities

The agent is responsible for managing and resolving customer complaints and escalations through a professional workflow system. This includes conducting investigations, performing root cause analysis, and collaborating with internal departments to ensure timely resolutions.