Bdm Bdm

Results-driven Claims Specialist and Customer Success professional with 5+ years of experience in high-volume medical aid claims processing, service excellence, and client relationship management at one of South Africa's largest healthcare companies. Holds an LLB Law degree, providing strong analytical capability, compliance awareness, and contract interpretation skills directly applicable to remote roles in claims operations, legal operations, healthcare administration, and customer success. Consistently ranked in the top 5–10% of performance metrics across volume, quality, and customer satisfaction.

Highly adaptable, detail-oriented, and effective in fast-paced, target-driven environments.

Claims Specialist at Discovery Health Pty/Ltd (2024-01 – Present)

• Process and resolve up to 100 high-value medical aid claims per day submitted by doctors, hospitals, specialists, and other healthcare providers registered with the Discovery Health Medical Scheme.
• Ranked in the top 5 for daily claims volume within 2 months of joining the department, demonstrating exceptional onboarding speed and performance ramp-up in a complex, regulated environment.
• Conduct thorough adjudication of large-ticket claims, applying medical scheme rules and regulatory frameworks to ensure accuracy, compliance, and risk mitigation.
• Identify and resolve complex billing discrepancies and query patterns through root cause analysis, reducing re-submission rates and improving processing efficiency.
• Collaborate with clinical and administrative teams to resolve disputed or incomplete claim submissions within defined SLA timeframes.

Health Partners Service Consultant at Discovery Health Pty/Ltd (2021-01 – 2024-01)

• Delivered end-to-end service support to Discovery Health Medical Scheme members and healthcare partners across a high-volume, multi-channel customer service environment.
• Maintained a top 10% performance ranking for two consecutive years across key KPIs including call quality score, first-call resolution rate, and customer satisfaction index.
• Received the Award of Excellence for zero defects across all calls, written communications, and customer interactions over a 24-month period — a distinction awarded to fewer than 10% of consultants.
• Managed complex member queries involving benefit calculations, claims disputes, authorisation appeals, and escalations, consistently achieving first-call resolution.
• Mentored and supported junior consultants as part of Discovery Health's Accredited Management Mentorship Programme.

Independent Sales Contractor at Tiger Wheel & Tire / Road Protect (2016-01 – 2016-12)

• Developed and executed marketing and sales campaigns aligned with company revenue targets in a competitive, target-driven retail environment.
• Led, motivated, and coordinated a sub-sales team to achieve collective sales objectives and performance benchmarks.
• Built and maintained customer relationships that generated repeat business and referral pipelines.

LLB (Bachelor of Laws) in Law – University of the Free State (2017-01 – 2021-12)

National Senior Certificate – Ladybrand High School (2010-01 – 2014-12)