Health Executive – Operations at Kaelo

Job Description

About the Role

• We are seeking an experienced and strategic Health Executive: Operations to lead and optimise all operational functions within our health insurance business. This is a critical executive leadership role responsible for ensuring the efficient, compliant, and customer-centric delivery of services across the full operational value chain.
• The successful candidate will play a key role in driving operational excellence, enhancing member and stakeholder experience, and enabling sustainable business growth through strong leadership, governance, and continuous improvement.

Key Responsibilities
Operational Leadership & Strategy

• Develop and execute operational strategy aligned with overall business objectives
• Translate strategic priorities into actionable plans across all operational divisions
• Foster a high-performance, service-oriented culture
• Ensure alignment across operations, product, distribution, and clinical teams

Oversight of Core Operational Functions
Lead and ensure performance across:

• Claims Management – adjudication, clinical validation, fraud prevention, and cost control
• Underwriting & Policy Administration – risk assessment, onboarding, and policy lifecycle management
• Customer Service & Call Centre Operations – multi-channel member and broker support
• Provider Network & Hospital Relations – contracting, partnerships, and service quality oversight
• Membership Onboarding & Servicing – seamless onboarding and ongoing member administration
• Billing Administration – premium billing, collections, reconciliations, arrears management, and financial accuracy in partnership with Finance
• Virtual Care & Digital Health Services – telemedicine, digital platforms, and remote care innovation
• Scheme / Product Administration – administration of benefits and scheme rules in line with regulatory requirement

Customer & Stakeholder Experience

• Champion a customer-centric operating model
• Improve turnaround times, service quality, and first-contact resolution
• Build strong relationships with members, providers, brokers, and regulators
• Monitor and enhance satisfaction and retention metrics

Financial & Performance Management

• Manage operational budgets and drive cost efficiency initiatives
• Improve cost-to-serve and operational productivity
• Establish and monitor KPIs, dashboards, and reporting frameworks
• Identify opportunities for operational scalability and efficiency

Governance, Risk & Compliance

• Ensure adherence to all regulatory and compliance requirements
• Oversee operational risk management, including fraud mitigation
• Maintain strong internal controls and audit readiness
• Partner with Risk and Compliance functions to uphold best practices

Process Optimisation & Digital Enablement

• Lead continuous improvement initiatives (Lean, Six Sigma, automation)
• Drive digital transformation across operational processes
• Enhance system integration, data usage, and decision-making capabilities
• Improve operational resilience and scalability

People Leadership & Culture

• Lead, mentor, and develop a team of operational leaders
• Build leadership capability and succession pipelines
• Foster an inclusive, collaborative, and high-performance culture
• Drive employee engagement, accountability, and retention

Qualifications

Key Requirements

Qualifications

• Bachelor’s degree in Business, Healthcare Administration, Actuarial Science, or related field
• Postgraduate qualification (MBA or equivalent) preferred

Experience

• 10–15 years’ experience in health insurance, medical schemes, or healthcare funding
• 5–8 years in a senior operational leadership role
• Proven experience managing complex, large-scale operational environments

Knowledge & Skills

• Strong understanding of health insurance operations and regulatory frameworks
• Financial acumen with data-driven decision-making capability
• Expertise in operational excellence methodologies
• Experience in digital transformation and process automation
• Excellent leadership, communication, and stakeholder management skills
• Ability to balance strategic thinking with operational execution

Leadership Attributes

• Customer-first mindset
• Results-driven with strong execution capability
• High integrity and sound judgment
• Resilient and adaptable in a dynamic environment
• Collaborative, people-centered leadership style