CURRICULUM VITAE
OF
THERESA CLOETE
THERESA CLOETE
Gender Female
Nationality South African
Ethnic Group Coloured
Language English, Afrikaans
Drivers Licence Code 08
Marital status Married
Dependants None
Desired job location Springbok, Northern Cape
Availability One calendar month
Contact Details
Cell phone +27-84-587-****
Email *********.**.**@*****.***
Residential Location Bergsig, Springbok, Northern Cape, South Africa Professional Profile
An experienced Escalations Team Leader with over 4 years’ experience in the medical health industry. Strong investigative skills, providing comprehensive feedback to relevant stakeholders and assisting with and solving claims related escalations. Currently seeking a position in order to grow and develop full potential. Education
2010
University of the Western Cape
B.Comm Degree majoring in Management
2005
Parow High School
Grade 12 (Matric with exemption)
Professional Courses / Training
Personal Mastery and Emotional Intelligence / 2014
Claims School / 2012
Computer Skills
Microsoft Office (Word, Excel, PowerPoint)
Areas of Expertise
Assessing quality of staff responses.
Coaching and advising staff with regards to queries received.
Investigating claims escalations.
Referring technical issues for further investigation impacting on claims.
Providing feedback with regards to claims
investigations.
Responding to escalations within 24 turnaround
time.
Client relations.
Quality control.
Workflow and process management.
Career History
1.1 2015 - PRESENT
World Marine Energy
Springbok, Northern Cape
ADMINISTRATIVE ASSISTANT
Responsibilities
Arranging meetings.
Typing minutes of meetings.
Filing documentation.
Assisting with company registration on database.
Ensuring follow-ups to enquiries sent.
General enquiries with regards to potential business.
Adhoc duties as required.
3
1.2 2014 – 2015
Metropolitan Health (MH)
Cape Town, South Africa
CLAIMS ESCALATIONS TEAM LEADER
Escalations – Claims Department
Responsibilities
Ensuring compliance with agreed service level agreements entered into with the client.
Managing and controlling workflow and process.
Handling system administration and enhancements.
Quality management and control.
Managing, developing and coaching staff.
Assisting with and facilitating projects.
Conducting written and verbal communications with service providers and business partners.
Ensuring that business partner interfaces are functional and developing / improving new processes.
Handling database extractions.
Liaising with IT Programmers and Developers.
1.3 2013 – 2014
Metropolitan Health (MH)
Cape Town, South Africa
CLAIMS SPECIALIST
Claims Department
Responsibilities
Investigating escalated complaints.
Assessing EDI and paper claims with various disciplines.
Ensuring that claims are processed accurately and within the agreed turnaround time.
Ensuring good quality feedback to queries received.
Processing claims where necessary.
Liaising with external business parties – SPN’s as well as different internal clients.
Loading filters.
Investigating stale claims.
Dealing with telephonic queries.
Archiving correspondence received and sent on the Reflections system.
Executing instructions (payments) received from clients in an accurate manner.
Attending to multiple workflow items.
Allocating work on the EG system to fellow colleagues.
Conducting case receipting work on the EG system. 1.4 2012 – 2013
Metropolitan Health (MH)
Cape Town, South Africa
CLAIMS ASSESSOR
Claims Department
Responsibilities
Capturing and processing claims within the service level agreement.
Ensuring all claims are paid according to the rules of the Medical Schemes Act and Scheme rules.
Achieving predetermined standards and quality levels.
Handling quality control to ensure error is minimised.
Filing documentation where needed.
Escalating queries where necessary.
4
2. 2010 – 2012
Arora Lights Northgate
Cape Town, South Africa
ADMINISTRATIVE ASSISTANT
Responsibilities
Liaising with suppliers.
Ordering goods.
Stock receiving and capturing.
Dealing with returns and repairs.
Processing according to documents received.
Keeping track of invoices and credit notes.
Placing and following up on sales and stock orders.
Communicating with sales and distribution staff.
Handling daily cash ups.
Packing orders.
Handling administrative tasks.
Career History: Previous Positions
3.
FUNDRAISING SECRETARY (Volunteer)
St John and Paul Catholic Church
2009
Key Strengths
Well-organised; good planner and time-manager.
Ability to prioritise and deal effectively with a number of tasks simultaneously.
Excellent listener and communicator, effectively conveys information verbally and in writing.
A constructive team member who contributes practically to the success of the team.
Solid judgment and management skills to effectively deal with people's needs / issues.
Ability to interact with other people at all levels of the organisation.
Attention to detail.
Ability to delegate work depending on volumes of work received. Endorsements
“She is dedicated to her work and ensures that every task is completed perfectly. Theresa is an honest, reliable worker that takes initiative Jacques Boshoff, Managing Member, Arora Lights
“Miss Hendricks is a highly motivated, diligent and successful student. I have come to know Miss Hendricks as an ambitious, co-operative and open-minded person.” Marley Daghari, German Language Trainer References
Donovan Cloete
World Marine Energy - Director
Revasha Khan
Metropolitan Health Claims Manager
Janice Thyssen
Metropolitan Health Claims Specialist Team Leader