Special Cases Agent (Non-Clinical) at Medscheme - Polmed Medical Scheme (2018-04 – Present)
- Approve Appliances and/or Prosthesis based on the available benefits and limits, according to the motivation from the treating doctor.
- Provide communication/feedback to the members and healthcare provider on the outcome of the requested item(s).
- Assist in the negotiation of the estimates/quotations to eliminate or reduce co-payments on claims.
- Authorise and process benefit adjustment where applicable.
- Identify possible IOD claims submitted by healthcare providers.
- Liaise with SAPS IOD (Injury on duty) department regarding member's injuries sustain while on duty, medical aid health benefits and medical account payments.
- Check claims for approved and/or rejected claims and liaise accordingly to affected stakeholders.
- Refer confirmed IOD cases to the assessors for reprocessing of claims.
- Check if required documents are submitted by the member as according to COIDA billing, for the processing of invoices.
- Liaise with healthcare providers on confirmed IOD cases.
- Knowledge of Ex-Gratia, Medical Advisory and PMB.
- Process medical Scheme queries include but are not limited to investigation, researching, resolving and developing an appropriate response to the member and healthcare provider.
- Contribute to cost savings on the members' benefits and therefore assist with the financial goal and targets within the department.
- Administer the use of funds based on the benefits and limits available.
- Handle all queries in line with operational requirements and communicate outcomes to members and practices.
Additional Skills - User Acceptance Testing secondment at Medscheme - Polmed Medical Scheme (2025 – 2026)
- Seconded for UAT testing for year end 2025-2026.
- Capturing, processing and reprocessing of claims to ensure correct processing of benefit and limits as per Scheme rules.
- Escalate incorrect payment of claims for correction.
- Ensure that the Scheme rules for co-payments, age rules and gender rules apply appropriately.
- Identify incorrect and/or invalid codes/chargeable codes and recommend alternative codes for testing.
- Identify system errors and escalate for correction based on the Scheme rules.
- Assist in identifying possible scenarios for testing benefits and limits and report on the outcome with possible solutions.
- UAT test validation.
Additional Skills - Weight Management Program (Health Coach) at Medscheme - Polmed Medical Scheme
- Identify qualifying members for the program.
- Recommending and Enrolment for the program.
- Furnish to members with the Care Plan and benefits of the program.
- Follow up consultations.
Special Cases Agent (Non-Clinical) at Medscheme - Bonitas Medical Scheme (2017-09 – 2018-03)
- Mas and Exclusion overrides of appliance and prosthesis.
- Follow work instructions on processes for members applications.
- Authenticate submitted documents of request for approval of Appliances and/or Prosthesis.
- Authorise and process requested item(s).
- Administer the use of funds based on the benefits and limits available.
- Check for approved and/or rejected Appliance claims and liaise accordingly.
Operations and Logistics Coordinator at Nguquko Coaching - Life & Business Coaching (2014-02 – 2015-10)
Reason for leaving: Personal
- Ensuring that all work and tasks are completed in a timely manner, branded and produced to the highest possible standards for each client.
- Liaise and communicate with clients effectively and address all their payment queries, special requests and ensure exceptional customer service is always given to them.
- Proactively seek opportunities to contribute to client retention and client satisfaction by ensuring that all project deliverables are met and exceeded expectations.
- Oversee and monitor the overall training and facilitation delivery process per coaching session.
- Efficiently prepare and manage all Public Relations campaigns end-to-end.
- Arrange and coordinate the logistics as per project/contract requirements in terms of training material, equipment, venues and any other required resources.
- Assist the Managing Director in designing and developing materials based on desired outcomes of each Life and/or Business Coaching session.
- Assist the Managing Director in preparing a budget for each project and ensuring the budget is kept.
- Manage all the quotation and invoice tasks for each account.
- Responsible for preparing payment and reconciliation reports for each account.
- I fulfilled the role of Office Manager and handled all administrative tasks needed to run an office effectively and efficiently.
- Responsible for preparing status reports for each business coaching/training session, for an average of eight (8) training sessions per month.
- Manage day-to-day operational tasks in the business such as procuring new stationery, meeting preparations and setup, calendar coordination and appointment confirmations with all clients.
- I participate in the development of Nguquko Coaching business strategies and the implementation thereof.
- Demonstrated the ability to cope under pressure, to think and act promptly as well as take on a leadership role in the absence of the Managing Director.
- Hands-on in managing the overall running of the operation to ensure compliance with relevant legislation, regulations and standards, financial and operational standards as well as meeting the needs of our clients and stakeholders.
Service Management Consultant (Back Office) at Inter-Active Technologies (Neotel Call Centre) (2012-09 – 2014-01)
Reason for leaving: New opportunity at Nguquko Coaching
- Documentation and analysis of current and future processes/systems within Customer Services.
- Proactively develops a collaborative relationship with the Customer Services and the Back Office.
- Acts as main point of contact between the Customer Services, 2nd Line Support Team and Management.
- Day-to-day management of Reports and productivity of the Back office Team.
- Quality assures the work of 2nd Line Support Team assigned to the project.
- Encourages the transfer of product knowledge and skills to the appropriate staff within the Call Centre.
- Monitoring project progress and performance of the 2nd Line Support Team.
- Liaison officer between Finance Manager, IT Support Team and the Referrals department.
- Support of customer relationship management systems and processes.
- Resolving cross-functional issues at junior level.
- Handling & Dealing with Customer or client relations on Accounts.
- Handling & Dealing with Customer or client relations on Value Added Services.
- Document Controller i.e. filing SMMEs, RICA & Contracts and Applications of the clients.
Administrator & Assistant Manager at SORBET (2008-11 – 2012-03)
Reason for leaving: To complete studies
- Demonstrate a high level of integrity, professionalism and trustworthiness towards clients and staff members.
- Initiate and participate in creating a fun and productive atmosphere for all staff members and therapists.
- Perform administrative and management activities by ensuring completeness of attendance register, staff shifts, handle all leave requests, and ensure punctuality.
- Have demonstrated accurate time management skills on all bookings for guests and shift schedule for staff members. Ensure that therapists are evenly scheduled.
- Fulfill the role of staff and customer relationship manager for the Salon.
- Demonstrated the ability to manage workload, prioritize activities, and work overtime when necessary.
- Perform stock count and consumables management activities for entire Salon and report on them.
- Proactively motivated and positively influenced staff members.
- Create a playlist of various appropriate genres of music to ensure a refreshing and peaceful experience for clients.
- Manage all Salon communication received via email, faxes and voicemails and act accordingly.
- Maintain appropriate and welcoming presentation of the Salon's front desk neat, retail and surrounding areas.
- Facilitate the preparation of all therapists and rooms to be ready for business.
- Conduct general product marketing and promotional activities.
- Ensure that worker environment adheres to and complies with hygiene, security and friendliness control standards.
- Ability to demonstrate issue escalation management and conflict resolution skills by addressing and follow up on all customer complaints.
- Perform cash-flow management activities and account for all transactions to ensure accuracy in banking procedures.
- Record, track and update consultations cards for new and existing guests.
- Responsible for ensuring accuracy of pricing, bar-coding, visibility of tickets and stickers.
- Conduct sales figures updates on noticeboards and other forms of communications received from Head Office.
- Ensure that refreshments are readily available for guests.
- Report on any Salon maintenance needed.
- Tracking of invoices, payments and ensuring suppliers are on the system.
- Setting up meetings.
- Checking and maintaining standards of corporate identity.
- Assisting with compiling and distribution of newsletters and product material.
