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  • Posted: Sep 17, 2025
    Deadline: Not specified
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  • Kaelo provides innovative, essential, healthcare solutions enabling the physical and psychological well-being of all South Africans. Our one goal is to provide more South Africans with access to quality healthcare. We are progressive in our design, simple in our approach and sincere in the way we engage, changing the way healthcare is delivered to meet th...
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    Gap Claims Specialist

    Job Description

    • The Claims Specialist manages the assessment 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

    Key Outcomes

    • The accurate and efficient processing of claims captured
    • Ad hoc duties- support in the operation of other divisions
    • 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
    • Contribute toward risk management
    • Assist clients with queries and provide suitable query resolution
    • Accurate completion of administrative targets on a daily basis
    • Dealing with multiple telephonic queries from members, brokers and franchises
    • Ongoing feedback to clients
    • Ad hoc functions as required by Management

    Qualifications

    Work Experience 

    Required

    • Insurance Industry Experience 

    Preferred 

    • Health Insurance Industry Experience 

    Education, Qualifications and Accreditation with Professional Body 

    Required

    • Matric 
    • FAIS / RE5

    Preferred 

    • FAIS / RE5 Accreditation with minimum 120 credits 

    Technical Skills or Knowledge  

    Required

    • Computer Literate incl. Microsoft Access

    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

    Check how your CV aligns with this job

    Method of Application

    Interested and qualified? Go to Kaelo on jobs.smartrecruiters.com to apply

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