Health Claims Administrator
- Full-time
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 Kaelo Health Claims Administrator is responsible for the management of all gap cover related tickets and correspondence. The responsible person captures all gap cover claims and corresponds with the membership base. This individual has knowledge of the gap claims environment. There is a strong focus on accurately and efficiently resolving the claim ticket received whilst ensuring effective communication and exceptional customer service and satisfaction.
KEY OUTCOMES
(not limited to) Level 4 and 5 process elements
The accurate and efficient capturing of claims received
Assist Kaelo clients with queries and provide suitable query resolution
Accurate completion of administrative targets on a daily basis
Dealing with multiple queries from Kaelo members and intermediaries
Ongoing feedback to clients
Management of all claim related mailboxes
Ad hoc functions as required by management
SPECIAL REQUIREMENTS
Good communication skills
Analytical ability
Time management
Team work
Customer focus
Data capturing experience
Qualifications
PERSON DETAILS: WORK EXPERIENCE
REQUIRED
Insurance industry experience
2-5 Years experience in claims handling
PREFERRED
Health Insurance industry
EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY
REQUIRED
FAIS
REQUIRED
Grade 12 – Matric
PREFERRED
RE5 certificate
TECHNICAL SKILLS OR KNOWLEDGE
REQUIRED
Computer literate, including Microsoft Access and Intermediate Excel Skills.
PREFERRED
Experience on MIP system
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