Health Claims Administrator

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

KEY OUTCOMES

(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

Ad hoc functions as required by management

Qualifications

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

REQUIRED

Grade 12 – Matric

PREFERRED

RE5 certificate

TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED

Computer literate, including Microsoft Access and Intermediate Excel Skills.

PREFERRED

Experience on MIP system

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