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

The 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 

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 on boarding for new employees.
• Review , maintenance and improvement of all processes and document management
• Quality assurance and trending
• Contribute toward risk management

Work Experience 

Required 

• Insurance industry experience
• Claims experience
• Team management and leadership experience

Qualifications 

Required 

• Grade 12 – Matric
• RE 5
• Accreditation would be advantageous (a minimum of 120 credits)

Technical Skills or Knowledge 

Required 

• Computer literate, including Microsoft Access
• Health / Medical Scheme Claims knowledge

1.      Accountability
2.      Action orientated
3.      Communication
4.      Business writing skills
5.      Manages complexity
6.      Problem solving skills
7.      Encourages engagement
8.      Planning and organisation
9.      Resilient and adaptive
10.      Systems thinking and connecting ability
11.      Purpose driven
12.      Significance and values orientated