Health Escalations Agent

Company Description

About KaeloKaelo 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 Escalations Agent is responsible for handling customer complaints, queries, and escalations in a professional, timely, and customer-focused manner.

Key Responsibilities

• Receive and manage complaints and escalations through the relevant workflow system.
• Investigate complaints by gathering all necessary information and supporting documents.
• Respond to members, providers, and other stakeholders clearly and professionally.
• Send first responses and ongoing updates within agreed service levels.
• Ensure complaints are resolved as quickly and effectively as possible.
• Use the correct templates and processes when communicating outcomes.
• Keep accurate records of all actions taken on the system.
• Capture the correct complaint details, categories, and outcomes for reporting purposes.
• Complete root cause analysis, remedial actions, and preventative actions where required.
• Escalate complex, regulatory, or sensitive matters to management when needed.
• Work closely with internal departments to obtain information and drive resolution.
• Maintain high standards of customer service, quality, and compliance.
• Support audit, reporting, and continuous improvement processes.

Qualifications

Required

MatricPreferredRE1Knowledge/Experience: 1-2 years’ experience in the Health Insurance industry, in complaints handling, customer service, claims, or escalations is advantageous

Key Requirements

• Strong written and verbal communication skills
• Good investigation and problem-solving ability
• Strong attention to detail
• Ability to manage difficult complaints professionally
• Ability to work under pressure and meet deadlines
• Understanding of SLA-driven environments and compliance processes is beneficial

Additional Information

Why Join Us?

This is an opportunity to play a critical role in improving healthcare quality, protecting patients, strengthening organizational integrity, and driving meaningful change. You will work alongside passionate professionals in an environment that values innovation, accountability, collaboration, and continuous improvement.

If you are ready to make a measurable impact and help shape a safer, higher-quality, and more resilient healthcare organization, we encourage you to apply.