Website Kaelo
Kaelo provides innovative, essential, healthcare solutions enabling the physical and psychological well-being of all South Africans. Our one goal is to provide more South Africans with access to quality healthcare. We are progressive in our design, simple in our approach and sincere in the way we… read more engage, changing the way healthcare is delivered to meet the needs of our people.
Job Description
About the Role
We are seeking an experienced and strategic Health Executive: Operations to lead and optimise all operational functions within our health insurance business. This is a critical executive leadership role responsible for ensuring the efficient, compliant, and customer-centric delivery of services across the full operational value chain.
The successful candidate will play a key role in driving operational excellence, enhancing member and stakeholder experience, and enabling sustainable business growth through strong leadership, governance, and continuous improvement.
Key Responsibilities
Operational Leadership & Strategy
Develop and execute operational strategy aligned with overall business objectives
Translate strategic priorities into actionable plans across all operational divisions
Foster a high-performance, service-oriented culture
Ensure alignment across operations, product, distribution, and clinical teams
Oversight of Core Operational Functions
Lead and ensure performance across:
Claims Management – adjudication, clinical validation, fraud prevention, and cost control
Underwriting & Policy Administration – risk assessment, onboarding, and policy lifecycle management
Customer Service & Call Centre Operations – multi-channel member and broker support
Provider Network & Hospital Relations – contracting, partnerships, and service quality oversight
Membership Onboarding & Servicing – seamless onboarding and ongoing member administration
Billing Administration – premium billing, collections, reconciliations, arrears management, and financial accuracy in partnership with Finance
Virtual Care & Digital Health Services – telemedicine, digital platforms, and remote care innovation
Scheme / Product Administration – administration of benefits and scheme rules in line with regulatory requirement
Customer & Stakeholder Experience
Champion a customer-centric operating model
Improve turnaround times, service quality, and first-contact resolution
Build strong relationships with members, providers, brokers, and regulators
Monitor and enhance satisfaction and retention metrics
Financial & Performance Management
Manage operational budgets and drive cost efficiency initiatives
Improve cost-to-serve and operational productivity
Establish and monitor KPIs, dashboards, and reporting frameworks
Identify opportunities for operational scalability and efficiency
Governance, Risk & Compliance
Ensure adherence to all regulatory and compliance requirements
Oversee operational risk management, including fraud mitigation
Maintain strong internal controls and audit readiness
Partner with Risk and Compliance functions to uphold best practices
Process Optimisation & Digital Enablement
Lead continuous improvement initiatives (Lean, Six Sigma, automation)
Drive digital transformation across operational processes
Enhance system integration, data usage, and decision-making capabilities
Improve operational resilience and scalability
People Leadership & Culture
Lead, mentor, and develop a team of operational leaders
Build leadership capability and succession pipelines
Foster an inclusive, collaborative, and high-performance culture
Drive employee engagement, accountability, and retention
Qualifications
Key Requirements
Qualifications
Bachelor’s degree in Business, Healthcare Administration, Actuarial Science, or related field
Postgraduate qualification (MBA or equivalent) preferred
Experience
10–15 years’ experience in health insurance, medical schemes, or healthcare funding
5–8 years in a senior operational leadership role
Proven experience managing complex, large-scale operational environments
Knowledge & Skills
Strong understanding of health insurance operations and regulatory frameworks
Financial acumen with data-driven decision-making capability
Expertise in operational excellence methodologies
Experience in digital transformation and process automation
Excellent leadership, communication, and stakeholder management skills
Ability to balance strategic thinking with operational execution
Leadership Attributes
Customer-first mindset
Results-driven with strong execution capability
High integrity and sound judgment
Resilient and adaptable in a dynamic environment
Collaborative, people-centered leadership style
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