Experience

Optivest Health Services

• South Africa
• Insurance
• 1 - 100 Employee

• Customer Service Specialist

  • Jul 2019 - Present

  Position Held: Member Services Consultant Period of Employment: 01 July 2019 to date Duties: Claims, Premiums, New Membership Applications; Benefit confirmation Membership Administration and Enquiries Resignations; Re-instatements Membership updates; Banking Details Registration of dependants Position Held: Member Services Consultant Period of Employment: 01 July 2019 to date Duties: Claims, Premiums, New Membership Applications; Benefit confirmation Membership Administration and Enquiries Resignations; Re-instatements Membership updates; Banking Details Registration of dependants



MEDSCHEME HOLDINGS

• South Africa
• Financial Services
• 400 - 500 Employee

• Pre-Authorisation Consultant

  • Aug 2016 - Jun 2019

  All calls answered according to set standards Transfer calls only when no further assistance can be rendered Maintain accurate details of pre-authorization information Confirm scans according to set protocols Check validity of membership Ensure that the reason for admission is appropriate Requesting BHF/ ICD and CPT and motivation letters on pre-authorisation, when necessary Offer transfers for members who need more medical information about medical procedures, etc. Follow- up urgent queries Capture messages on the system Give authorisation numbers for cases that are already loaded Provide product information to all clients in line with standards and protocols of the call centre Maintain confidentiality To provide all members, providers and internal staff with a first time resolution regarding requests for pre-authorisation as underpinned by the scheme rules and as per contractual obligations, in order to provide quality service within the required service Levels, Business Unit protocols and regulatory requirements. Show less



Liberty Medical Health Scheme

• Ghana
• Insurance
• 1 - 100 Employee

• Client Services Agent

  • Dec 2009 - Jul 2016

  Duties: Claims, Premiums, Debtors review New Membership; Benefit confirmation Membership Administration and Enquiries Resignations; Re-instatements Membership updates; Banking Details Registration of dependants Correspondence Agent (Email Enquiries) Responding to all faxes and emails received: Tax Certificates Drafting of Manual Tax Certificates and Tax Reports. Tax Breakdowns for Liberty Medical Scheme. Successor During this time, I was a Pre-authorization consultant: My duties where to provide all members and providers with a first-time resolution regarding requests for pre-authorisation as underpinned by the Scheme rules and as per contractual obligations, in order to provide quality service within the required Service Levels, Business Unit protocols and regulatory requirements. Facilitation of all inbound pre-authorization requests, queries in order to provide resolution to meet the customers’ specific needs. Show less



Metropolitan Health Group

• South Africa
• Health, Wellness & Fitness
• 700 & Above Employee

• Call Centre Agent (Administer GEMS) (Government Employees Medical Aid Scheme)

  • Nov 2006 - Nov 2009

  GEMS product to potential members; Confirming Receipt of applications received; Membership Enquiries Claims Enquiries Benefit Confirmation Premium Management Clerk Premium Enquiries / Persal Members Premium Escalation Enquiries VIP Members Successor Managing inbound and/or outbound calls Keeping records of all conversations Building product knowledge GEMS product to potential members; Confirming Receipt of applications received; Membership Enquiries Claims Enquiries Benefit Confirmation Premium Management Clerk Premium Enquiries / Persal Members Premium Escalation Enquiries VIP Members Successor Managing inbound and/or outbound calls Keeping records of all conversations Building product knowledge