Gap Claims Operations Team Leader

Kaelo; South Africa; On-site; ZAR 350,000 - 500,000; Full time

Job summary

A healthcare solutions provider is seeking a Gap Claims Team Leader in South Africa. This role requires managing claims authorizations and leading the team to ensure customer satisfaction. Ideal candidates will have experience in the insurance industry, particularly in claims, with strong communication and analytical skills. A Matric qualification and the RE 5 accreditation are required. This position offers the opportunity to drive process improvements and foster a collaborative team environment.

Qualifications

• Strong communication skills are essential for this role.
• Analytical ability is necessary to resolve claims accurately.
• Experience in customer interaction and pressure management is required.

Responsibilities

• Manage the authorisation of claims and enhance customer satisfaction.
• Lead and motivate the claims team effectively.
• Ensure adherence to SLA and contribute to continuous improvement.

Skills

Communication skills

Analytical ability

Time management

Customer focus

Ability to adapt

Ability to cope under pressure

Education

Grade 12 – Matric

RE 5

Accreditation (120 credits)

Tools

Microsoft Access

Gap Claims knowledge

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.

Responsibilities

• The Gap Claims Team Leader manages both the authorisation of claims and has specialised knowledge of the claims environment with a strong focus on accurately and efficiently resolving the claim received while ensuring exceptional customer service and satisfaction.
• Leads the claims team to carry out their responsibilities while keeping the team motivated and efficient, working closely with the Claims Manager and Claims Operations Executive.
• Monitor the daily dashboard to ensure adherence to SLA, supervise accurate and efficient processing of claims, and contribute towards continuous improvement and innovation at process and procedure level.
• Ensure that all claims processing and queries are attended to accurately and within the agreed turnaround time.
• Monitor daily performance statistics and workforce management; manage daily claims focus and work allocation.
• Assist clients with escalated queries and provide suitable query resolution.
• Perform people management tasks on a daily basis and provide ongoing feedback to clients.
• Promote participative leadership and strong communication within the team; collaborate with all business areas.
• Coach and facilitate peer-to-peer learning; contribute to knowledge and quality management.
• Develop all employees and ensure smooth onboarding for new employees; review, maintain and improve processes and document management; ensure 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

Work Experience

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

Education and Accreditation

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

Technical Skills

• REQUIRED: Computer literate, including Microsoft Access; Gap Claims knowledge
• PREFERRED: