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

Health and Life Claims Team Leader manages both the authorisation of claims and has specialised knowledge of the claim’s 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 Health Operations Manager

KEY OUTCOMES

Determines claims operational strategies by conducting:

- Assessments

- Performance Review

- Capacity Planning

- Productivity Quality

- Customer service standards

Maintains and improves claims operations by monitoring system performance.

Accomplishes people objectives by recruiting, selecting, training, assigning, couching, counselling and disciplining employees.

Pre-pare claims performance report by collecting, analysing, and summarising data and trends.

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 daily

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.

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

2+ years claims experience.

FAIS (minimum 120 credits)

1+ years management experience

PREFERRED

2+ years Health Insurance Experience

2+ years Life Insurance Experience

EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY

REQUIRED

Grade 12 – Matric

PREFERRED

RE5 Accreditation would be advantageous.

TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED

Computer literate, including Microsoft Office

MIP

Putty

Fresh Works (advantageous)

      Accountability

      Action orientated

      Communication

      Business writing and presentation skills

      Problem solving skills

      Creative thinking         

      Strong relationship skills

      Growth and development mind-set     

      Planning and organisation

      Resilient and adaptive     

      Systems thinking and connecting ability     

      Professional and brand conscious

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