Job 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.

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

Additional Information

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.