Kaelo
Health Claims Administrator
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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
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(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
Qualifications
- Ad hoc functions as required by management
- Insurance industry experience
- 2-5 Years experience in claims handling
- 5 Years experience in claims handling
PREFERRED
- Health Insurance industry
EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY
REQUIRED
- FAIS
- Grade 12 – Matric
PREFERRED
- RE5 certificate
TECHNICAL SKILLS OR KNOWLEDGE
- Computer literate, including Microsoft Access and Intermediate Excel Skills.
PREFERRED
- Experience on MIP system
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Additional Information
PERSONAL ATTRIBUTES: COMPETENCIES
- Sound knowledge and experience in the provision of Occupational Health and Primary Healthcare, IOD and medical emergencies
- Conducting medical surveillance examinations
- Interpret and record medical surveillance findings and refer medical surveillance findings to Occupational Health Medical Practitioner
- Document management
- Health Risk assessment knowledge
- Ensure legal compliance of on-site clinic
- Qualifications: Professional Nurse and a Qualification in Occupational Health will be an advantage
- Up to date and relevant registration with SANC, SASOHN and DoH
- Certificate in dispensing, audiometry and spirometry
- Computer literacy (Ms Office, Word, Excel, Outlook and PowerPoint).
- Customer orientation, focus on excellence and teamwork
- Ethical behaviour
- Excellent communication skills
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