Experience

MEDSCHEME HOLDINGS

• South Africa
• Financial Services
• 400 - 500 Employee

• Non Clinical Prospective Reviewer: Bonitas Medical Fund

  • Dec 2017 - Present

  - Authorise hospital authorisation requests by applying coding principles, Scheme rules and benefits, and managed care policies and processes.- Capture accurate pre-authorisation data on the system.- Correctly escalate complex clinical call.- Resolve problems and escalate unresolved issues to higher levels.- Ensure delivery targets/objectives are met and operate in a supportive manner to achieve successful delivery.- Facilitate and provide staff with training on internal processes in a one-on-one or group setting - ISO 9001 Roll-out Champion- Ensure ISO 9001 documents applicable to department meets formal requirements and required standard, and are loaded on ISO site- Create, update and manage ISO 9001 process documents in order to ensure ISO 9001 accreditation is obtained and maintained - Sorting, storing and retrieving ISO 9001 documents on behalf of management- Service Cost Savings Initiative Reports, ensuring initiatives are correctly applied and coaching provided where necessary - Obtain discounted prosthesis quotations to ensure cost savings objectives are met

• Administrative Assistant: Bonitas Medical Fund

  • Feb 2017 - Nov 2017

  - Provide general office administrative duties to staff and management.- Schedule meetings and interviews of departmental team leaders and managers.- Recruitment - Prepare interview documents. Manage and direct visitors for interviews to the relevant person(s) and/or boardrooms. Perform reference checks on successful candidates for employment.- Finalise successful candidate’s paperwork, system access and work stations etc.- Preparing/linking correspondence and documents for pre-authorisation files, to be processed by a clinical agent/case manager.- Create Pre-authorisation files (PAR’s), to be processed by a clinical agent/case manager.- Assist Pre-authorisation call centre to ensure that the SLA is maintained.- Train new staff on linking, telephone and printer usage.

• New Business Consultant: Liberty Medical Fund

  • Aug 2016 - Jan 2017

  - Quality Assessing - Fully capturing new member applications and activations, and registering of dependants, processed within SLA to maintain service excellence.- Registering of New Employer groups- Ensure that Audit reports are serviced daily, weekly or monthly.- Responsible for checking and authorising bank details loaded by capturer.- Take accountability for Team Leader escalations received and the resolving thereof.- WebRT (Process documents electronically): Complete and submit documents appropriately. Process outstanding information received, apply date changes accurately, respond to Financial Advisors and members directly and allocate tickets to respective queues/consultants within set time frame.- Telephonic follow-ups- EMI: Processing of EMI applications and adhering to strict TAT of 2 hours per application.- Quality checking of Acceptance letters prior to release.



Liberty Health

• South Africa
• Insurance
• 1 - 100 Employee

• New Business Consultant

  • Sep 2012 - Jul 2016

  - Fully capturing new member applications and activations, and registering of dependants, processed within SLA to maintain service excellence.- Registering of New Employer groups- Ensure that Audit reports are serviced daily, weekly or monthly.- Responsible for checking and authorising bank details loaded by capturer.- Take accountability for Team Leader escalations received and the resolving thereof.- WebRT (Process documents electronically): Complete and submit documents appropriately. Process outstanding information received, apply date changes accurately, respond to Financial Advisors and members directly and allocate tickets to respective queues/consultants within set time frame.- Telephonic follow-ups- EMI: Processing of EMI applications and adhering to strict TAT of 2 hours per application.- Quality checking of Acceptance letters prior to release.

• Document Management Consultant

  • Jan 2010 - Sep 2012

  - WebRT (Process documents electronically): Complete and submit documents appropriately. Process claims, membership changes, provider documents etc.- Handling correspondence and filing- Perform basic clerical duties including maintaining records and filing.- Updating records, correctly capturing/updating member changes.- Ensure that Audit reports are serviced daily, weekly or monthly.- Responsible for scanning documents received via post.- Providing training to new staff on various departmental functions.- Second in Charge (2IC): Responsible for assisting Team leader with various tasks.