Experience

Wesmart Healthcare Insurance

• South Africa
• Insurance
• 1 - 100 Employee

• • Jan 2021 - Present

  Responsible for ensure the timely and accurate administration and processing of claims. This is done through proactively assisting the Claims Manager, as to achieve high levels of satisfaction for the insured and broker through high quality claim management, resolution and excellent client serviceKey Responsibilities:• Provide organizational and administrative support to the Claims Manager.• Take inbound and make outbound calls according to claims enquiries, complaints or general claims queries.• Lodge and assess claims in line with policy terms and conditions and WESMART’s processes and protocols.• Support the Claims Manager in the delivery of an effective and efficient administration service .• Provide accurate daily /monthly statistics to Claims Manager.• Where necessary, produce and maintain spreadsheets, bordereaux and databases to enhance data presentation, analysis and storage.• Liaise with service providers, brokers and other stakeholders to support the effective management of claims.• Assist with the necessary auditing and reviewing of internal and external claim files.• Participate in cross-team and intra-team projects, as required.• Provide input to underwriters during the review of existing Insured’s claims experience.• Comply with standards for timeliness of contact, follow-up and payments.• Prepare claims summaries and respond promptly to queries.Skills and Abilities:• Accurate and numerate• Strong analytical skills with attention to detail• Computer skills – Good working Knowledge of MS Office, well developed spreadsheet skills• Able to communicate effectively with others, both verbally and in writing• The ability to manage time, meet deadlines and prioritiesKnowledge and Experience:• Functional knowledge & understanding: Claims management process• Proven administrative experience, preferably within the insurance or financial services sectors• Healthcare Insurance Experience• ICD10 + PMB knowledge Show less

• • Jan 2021 - Present

  • Dealing with brokers, groups queries, customer queries, complaints, policy servicing amendments, and all aspects of customer services in a competent• Take inbound and outbound calls. Document all call information according to standard operating procedures • Handle customer enquires both telephonically and by email • Respond to query emails within 8 hours• Manage and resolve customer complaints. Follow up on customer calls where necessary• Data verification, integrity, and accuracy• Demonstrate exceptional knowledge of products, processes, systems knowledge, client history, retention criteria, claim criteria, loss rations, and finances to provide an improved customer experience and retain the customer • Provide reports, presentations, and marketing material for Customer Service Manager and other staff as requested Show less



Gauteng department of Education

• Tholulwazi secondary school 11414 Tuketana street Tsakane, Brakpan, 1548

• Covid-19 Youth Brigade Programme

  • Jun 2020 - Sep 2020

  The Covid-19 Youth Brigades Programme is part of the departments overall plan to involve the youth in limiting community transmission and outbreaks within the education sector. Recruited Brigades will be placed in schools and government buildings to assist the department with the following: Screening of staff and learners Data capturing Monitor compliance e,g social distancing and sanitizing. The Covid-19 Youth Brigades Programme is part of the departments overall plan to involve the youth in limiting community transmission and outbreaks within the education sector. Recruited Brigades will be placed in schools and government buildings to assist the department with the following: Screening of staff and learners Data capturing Monitor compliance e,g social distancing and sanitizing.