Melicia Langeman

Handle all face-to-face enquiries received Follow up and finalize enquiries referred to other business units within agreed time frames Respond to all emails, web queries, posted queries / courier services, within allocated time frame

Customer Service Agent at Government Pensions Agency (2023-06 – 2025-05)

• Handle all face-to-face enquiries received
• Follow up and finalize enquiries referred to other business units within agreed time frames
• Respond to all emails, web queries, posted queries / courier services, within allocated time frame
• Update on all relevant GPAA systems
• Respond to escalated queries within allocated time
• Interact with the departments and members regarding outstanding queries
• Keep up to date on any changes happening in the various sections
• Provide / request feedback to various clients and stakeholders
• Follow-up with business units and provide feedback to clients until cases are finalized
• Effective administration of documents received in line with SOP
• Provide administrative support at outreach initiatives
• Report any issues/make recommendations with regards to ongoing service improvements and maintain a high level of client care
• Compile and submit daily, weekly and monthly production of statistics to the supervisor
• Check and update consolidated/escalation lists to the supervisor

Account Manager at Xpedient Medical (2022-06 – 2023-05)

• Receipting Practice Payments (Medical Aids & Members)
• Send updated and outstanding payment statements to patients/members
• Query unpaid claims with Funds and send through paper claims and accounts for reprocessing to the Fund
• Assist Dr's rooms with request e.g. Rebilling, Reversals and amendments of claims
• Refer claims back to fund for PMB reviewing in line with ICD10 code on claim
• Resubmit claims to Fund for authorization, to be linked to claim and amendments for incorrect billing, dependent code or service date

Administrator at Next BioSciences (Century City Covid Testing) (2020-12 – 2022-05)

• Register Clients for Covid Testing, Antigen /PCR
• Processing of payments and confirmation of benefits for Discovery clients
• Compiling daily stats for supervisor

Team Leader – Client Services with Walk in Centre at Samwumed (2019-08 – 2020-07)

• Managing and motivating a team of plus minus 10 agents
• Coaching and one on one feedback sessions
• Evaluation of calls and providing feedback
• Ensuring agreed SLA met
• Scheduling of breaks
• Drawing & compiling of daily & monthly reports and stats
• Managing unplanned absenteeism and leave requests
• Assisting with Escalated queries and Complaints
• Reworking or reprocessing of claims
• Dealing with disciplinary issues
• Uploading and discussing staff Performance contracts
• Discussing as well as uploading team members Appraisal
• Interviewing new candidates (recruitment and selection)
• Attend to irate clients in walk in centre (when requesting to speak to a senior)
• Created cases to medical advisor for claims where ICD10 codes are PMB and needs to be reviewed for full payment
• Created cases for medical advisor for claims to be paid out of Exgratia Fund
• Escalated cases where ICD10 Code steers claim to pay from Chronic Benefit
• Setting up Product knowledge tests for staff

Team Leader – Contact Centre with back office at Medscheme (2010-01 – 2018-06)

Previous Role/s: Clinical data capturer / Chronic call centre consultant. Department: Chronic Medicine Management – PCC and MML

• Managing and motivating a team of plus minus 14 agents
• Coaching and monthly one on one feedback sessions
• Evaluation of calls and providing feedback
• Ensuring agreed SLA met
• Drawing & compiling of daily & monthly reports and stats
• Managing unplanned absenteeism and leave requests
• Assisting with Escalated queries and Complaints
• Updating of Standard Operational Procedures
• Dealing with disciplinary issues
• Uploading and discussing staff Performance contracts
• Discussing as well as uploading team members Appraisal
• Setting up and interviewing new candidates through, Recruitment and selection process
• Assisting Health Care providers (pharmacists & doctors)
• Telephonic registration of chronic medication (capturing all drugs & motivations as well as updating new prescriptions received telephonically & manually)
• Explaining rejections of medications & authorizations to providers and members
• Assisting with all chronic medicine queries and escalating where required and referring to clinical guidelines & standard operational procedures

Call centre consultant at Old Mutual Healthcare / Lethimvula (2006-08 – 2009-12)

Department: Health Care-supplier line/ hospital line. Precertification / Confirmation.

• Confirmation of member benefits to service providers & assistants
• Service providers in all claim & benefit queries on both provider & hospital line
• Faxing & emailing of statements & reconciling accounts
• Assisting practices on all schemes administered by Omhc
• Precertification: authorizing hospitalization for members as well as procedures in doctor's rooms

Receptionist at Breakaway Systems (2005-12 – 2006-03)

• Filing, faxing, invoicing, banking, answering switchboard
• Updating of cashbook, printing statements, petty cash, payments on Pastel for suppliers
• Keeping record of stock

Call Centre Agent / Tracer at Edcon Financial Services (2001-01 – 2004-02)

Reason For Leaving: In Search of new opportunities

• Debt collecting & Tracing
• Phoning clients, negotiating payments
• Tracing clients on Itc, KI, Cybertel & telephone directories & 1023 (in and outbound call centre)

Sales Assistant at Galaxy Jewelers (1997-09 – 2005-10)

Duration: September 1997- Dec 2000 & Aug 2004-Oct 2005. Reason for Leaving: Casual Capacity

• Sales- one on one basis
• Debt Collecting- in store
• Basic admin, Customer service and Stock control

Matric – Wittebome Senior Secondary School – Wynberg (1996)

Diploma in Public Management – False Bay College

NQF Level 4 Qualification in Generic Management – Learning and Performance Academy (2018-10)