Escalations Team Leader

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.

Seeking a motivated and detail-oriented individual to join our Escalations team to lead and oversee the day-to-day operations of the Escalations Team to ensure complex and sensitive issues are resolved quickly, accurately, and within SLA. You’ll act as the key link between frontline agents, management, and external stakeholders, driving both team performance and process improvement.

Operational Leadership & Team Oversight

• Provide day‑to‑day operational leadership to the Escalations Team, ensuring work is managed efficiently and in line with agreed SLAs and quality standards.
• Act as the first point of escalation for complex or sensitive matters before escalation to management.
• Support operational continuity by acting as 2IC to the Escalations Manager during periods of leave or absence.

Workflow Management & Resource Allocation

• Allocate, prioritise, and monitor daily and weekly workflows across the Escalations Team to ensure targets are met and backlogs are proactively managed.
• Balance workloads to maintain productivity while protecting service delivery.
• Identify operational risks or capacity constraints early and escalate with proposed solutions.

Escalation & Portfolio Management

• Manage high‑profile escalation portfolios, including Centriq engagements and the majority of the Anglo portfolio.
• Ensure escalated cases are managed end‑to‑end with a strong focus on first‑time resolution, accuracy, and defensibility.
• Liaise with internal and external stakeholders to resolve complex claims and escalation matters efficiently.

Quality Assurance, Audits & Compliance Support

• Assist with internal and external audits by reviewing escalated cases, providing required documentation, and addressing findings.
• Conduct quality reviews on team members’ work to ensure adherence to policies, procedures, and regulatory requirements.
• Identify recurring errors, systemic issues, and training gaps within the team.

Performance Support & Team Development

• Provide ongoing guidance, coaching, and technical support to escalation agents.
• Lead by example through consistently exceeding performance targets and maintaining high processing standards.
• Foster a collaborative, motivated team environment that encourages accountability and operational discipline.

Operational Discipline & Process Improvement

• Drive adherence to processes and operational standards within the Escalations Team.
• Support identification and implementation of efficiency improvements and risk‑mitigation initiatives.
• Strengthen the sustainability and maturity of the Escalations function through consistent leadership and oversight.

Qualification:

Required

• Matric

• RE5

Preferred

• RE1
• Class Of Business Long Term & Short Term Insurance

Knowledge/Experience:

3-  5 years’ experience in the  Health Insurance industry.

Why Join Us?

This is an opportunity to shape and transform a core business function within a forward-thinking organisation. You will have the mandate to influence strategy, drive innovation, and lead a high-performing team in delivering exceptional service to members and stakeholders.