Manager Medical
Resume:
OBJECTIVE
To work in an environment which
encourages me to succeed and grow
professionally where I can utilize my skills
and knowledge appropriately.
PERSONAL DETAILS
Date of Birth : 15/02/1986
Marital Status : Single
Nationality : South African
Claims Investigator :
EDUCATION
UNISA
2015
COIDA
NQF5
Reservoir Hills Secondary High
2003
Matric
Exemption
REFERENCE
Michelle Govender - "Constantia Insurance"
Senior Operations Manager
*********@***************.**.**
Karabo Muaone - "FEM"
Claims Manager
*******@****.**.**
SKILLS
Time management, report writing, TCF, Team
work, Computer proficient
EXPERIENCE
ROXANNE ARUMUGAM
***************@*****.***
The Louries Fontein and Perm Street Sonneglans Randburg Roxanne Arumugam
Constantia Insurance
01 November 2019 - 31 May 2020
Claims Investigator
.Responsible for all activities pertaining to
Medical Claims and Claims assessing in terms of
Individual, Group Risk and Employee Benefit
products/ policies
· Maintaining turnaround times in terms of
service level agreements for the processing and
assessment of claims within prescribed times
· Full and accurate intimation of death,
disability and critical illness claims
· Preparation of claim with all required
documents as indicated by claim type ensuring
minimum requirements are adhered to prior to
assessing the claim
· Accurate updating of the claim status and
data relating to each claim on related business
system
· Follow up of outstanding requirements with
claimant as required in order to finalise a claim
· Collating of all relevant documentation
including an investigation report of EX gratia claim prior to sending to Management for approval and
payment
· Maintaining professional written
communication with claimant using approved
company templates
· Identifying and flagging fraudulent claims
and updating the RED list
· Adhering to life claims principles and
philosophies
· Maintain claims standards operating
procedures
· Document and highlight all concerns with
clients at regular monthly meeting with a solution orientated approach
· Where applicable attend monthly SAICB
meetings and provide feedback to team
· Ensure data integrity of claims information
for management reporting purposes
Assisting with telephonic queries
Scanning, emailing, etc
FEM
01 April 2011 - 31 March 2018
Medical Claims Assessor
. Registration of new I.O.D’s.
. Handling of all telephonic enquiries.
. Allocating of documents to claim numbers onto
the profem system.
. Indexing of documents on the profem system via
correct allocation of claim numbers.
. Scanning of documents onto profem via correct
allocation of claim numbers.
. Request all relevant documents to allocate to
claim to ensure a faster payout time period.
. Duplicate checking of documents.
. Destroying of documents on profem as well as
manual.
. Data capturing.
. Sorting of documents and allocation of claim
numbers.
. Assistance with remittance as well as other
payment enquiries.
. Ensuring that all new claims have the correct
information, correct documents and completion
of all questions.
. Assisting Reception.
. Full internal claims Assessor training (Coida Act 1993)
. Payment of medical accounts and refunds to the
employee and employer.
. Follow up on claim process
. Requesting medical reports from service
providers
. Calculating Permanent disability awards to pay
out to injured employees based on the medical
reports from the specialist or general practioner.
. Calculating monthly wages according to the
COID ACT
. Estimating the total cost of a claim.
. Finalization of claims
. Filing, Faxing, Emailing, etc.
Contact this candidate