Thobeka Fenele

Healthcare Administrator - Compendium Insurance Broker

(2023-05)

Assist clients (often employers or individuals) in navigating the complexities of healthcare insurance plans, policies, and benefits.
Educate clients on healthcare insurance options, benefits, coverage limits, and exclusions.
Provide ongoing support to clients regarding plan benefits, changes in coverage, and resolving policy-related issues.
Address and resolve client inquiries related to billing, claims, and coverage details.
Assist clients with the processing and tracking of healthcare claims.
Work with insurance carriers and healthcare providers to resolve claims issues, ensuring that claims are processed in a timely manner.
Serve as a liaison between clients, insurance companies, and healthcare providers to ensure proper reimbursement and benefits.
Maintain client records, manage documentation, and ensure that all paperwork related to health insurance policies is complete and up-to-date.
Handle billing and payment issues, ensuring that all client payments for premiums are processed correctly.
Prepare reports on insurance coverage, claims status, and other performance metrics for internal use or client meetings.

Medical Consultant - Momentum Medical Scheme

(2016-05 - 2023-04)

Explaining Coverage and Benefits: Consultants explain the details of different medical aid plans, including coverage limits, exclusions, premiums, co-payments, and other terms to ensure the client understands the benefits.
Assisting with Enrollment: They help clients through the process of enrolling in a medical aid scheme, ensuring all paperwork and documentation is completed correctly.
Claims Assistance: Consultants assist clients with submitting claims and may help resolve disputes or issues that arise with insurance companies or medical service providers.
Updating Clients on Changes: They keep clients informed about changes in healthcare policies, coverage options, and updates to the medical aid system that may affect them.
Providing Support with Pre-authorizations: For medical procedures that require pre-approval, consultants assist clients with submitting requests for authorization from the medical aid provider.
Troubleshooting and Problem Resolution: Addressing any issues clients have with their medical aid plans, such as disputes over claims, billing errors, or denied coverage.

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