Gap Claims Operations Team Leader

Kaelo; Durban; On-site; ZAR 400 000 - 600 000; Full time

Job summary

A healthcare solutions provider is seeking a Gap Claims Team Leader in Durban to manage claims and lead the team. The role involves ensuring exceptional customer service, monitoring performance statistics, and fostering a collaborative environment. Candidates must have prior experience in claims and team management along with strong communication and analytical skills. A Grade 12 and RE 5 are mandatory qualifications. This role offers an opportunity to contribute to the ongoing success of an essential team.

Qualifications

• Insurance industry experience required.
• Claims experience required.
• Team management and leadership experience required.

Responsibilities

• Manage the authorisation of claims efficiently.
• Motivate and manage the claims team.
• Monitor daily performance statistics.

Skills

Communication skills

Analytical ability

Time management

Customer focus

Ability to adapt to an ever changing environment

Problem solving skills

Education

Grade 12 – Matric

RE 5

Accreditation (minimum of 120 credits)

Tools

Microsoft Access

Job description

Overview

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 Gap Claims Team Leader manages both the authorisation 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. 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 Claims Manager and Claims Operations Executive.

Responsibilities

• Reporting and Managing Key Team Deliverables
• Monitoring 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 on a daily basis
• Ongoing feedback to clients
• 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

Qualifications

• Special Requirements
• Communication skills
• Analytical ability
• Time management
• Customer focus
• Ability to adapt to an ever changing environment
• Cope well under pressure

Experience

• Required: Insurance industry experience
• Required: Claims experience
• Required: Team management and leadership experience
• Preferred: Health Insurance industry

Education & Accreditation

• Required: Grade 12 – Matric
• Required: RE 5
• Accreditation would be advantageous (a minimum of 120 credits)
• Preferred: Accreditation would be advantageous (a minimum of 120 credits)

Technical Skills

• Computer literate, including Microsoft Access
• Gap Claims knowledge
• Preferred: Additional information

Personal Attributes

• Accountability
• Action orientated
• Collaborative
• Communication
• Business writing skills
• Manages complexity
• Problem solving skills
• Decision
• Growth and development mind-set
• Financial acumen
• Planning and organisation
• Resilient and adaptive
• Self-development
• Purpose driven
• Significance and values orientate