*

Alma van Zyl Special Case

Administrator

Address:

*** ************* ******, ********* ******,Roodepoort, 1735. Phone:

+27 (0-82-879-****

E-mail:

adl4f5@r.postjobfree.com.

EXECUTIVE SUMMARY

A highly experienced and motivated Medical Aid Administrator offering a total of 25 years’ experience in the Healthcare Industry which includes 24 years’ experience in administering Special Medical advisor and Ex Gratia cases.

I was responsible for administering and processing Special Medical Advisory and Ex-Gratia cases for Barlow’s Medical Aid Scheme and AECI Medical Aid Society.

Previously responsible for the medical aid schemes (the University of the Witwatersrand, Parliament

(PARMED) Ex-Gratia and Special Medical Cases).

Representing Medscheme Health Administrators at committee meetings presenting Special Medical and Ex- Gratia cases for consideration.

PERSONAL SKILLS/ COMPETENCIES

• Well organized and disciplined to work on my own.

• Understand the “Customer Experience”.

• Self-Motivation.

• Teamwork and a dedicated team member who works in a team towards a common goal to assist the client.

• Flexible and adaptable; Can work under pressure.

• Confident in specialist area of competence and expertise.

• Friendly and sincere.

• Does detailed work and performs my work accurately. Obtained 100% quality score on a monthly basis.

• Good listening skills.

• Client Orientation constantly helping members with their medical aid queries.

• Written and verbal communication skills efficiently convey share/ communicate information.

• Planning and organizing efficiently to achieve my work goals/set targets. 2

Additional Qualifications

• Matriculated

• Nexus in-house computerised system.

• Manual and Advanced Assessing.

• Time Management.

• MS Excel.

• MS Word.

• 23 years plus Medical Aid experience at Medscheme. WORK EXPERIENCE

Name of Company:

AKESO MILNERTON CLINIC

Period: 1 November 2019 – 28 February 2020.

I was contracted as a Receptionist on a temporary basis and with my medical aid experience management promoted me as an Admissions Representative. Shortly after this I was offered permanent employment. Admissions Representative:

Responsibilities:

• Collect accurate medical, personal and demographic data to facilitate proper patient care.

• Contact patient’s Insurance/Medical aid pre-authorisation department to obtain authorisation for admission.

• Entering patient information to pre-admissions database.

• Explain the hospital policy and patient rights during registration.

• Respond to patient’s question and complaints in a professional manner.

• Provide excellent service support to ensure customer satisfaction.

• Identify patients with no insurance or with financial liability and refer them to the Financial Counsellors or Case manager.

• Maintain clean and organized workstation.

• Collect payments from patients before discharge.

• Update the patient information systems and review it for accuracy according to regulatory compliance.

• Create a patient file and labels with patient’s records for the treating doctor and ward.

• Prepare admission related paperwork accurately to ensure timely admission process.

• Coordinate with Doctor’s, clinic departments, and care coordinators to facilitate smooth admission process for the patients.

3

• Arrange for patient placements, bed assignments, patient escort, and patient transfer activities after receiving the admission requests.

Reason for leaving: Relocated to Johannesburg.

AKESO REFERENCE:

Kim Anderson

087-***-****

adl4f5@r.postjobfree.com

Natalie Starita

087-***-**** Ext 5208

adl4f5@r.postjobfree.com

Name of Company:

MEDSCHEME

Period: 1 October 1995 – 31 July 2019.

Special Case Administrator:

Responsibilities:

• Receive cases per E-mail / Fax or post.

• Load on system “Nexus” to create a query number or reference number.

• Prepare case for Medical Advisor – contact Healthcare Professional or member for motivation or necessary medical information.

• Once cases have been approved, I need to do a system override on “Nexus Exclusion Override screen”.

• Replies sent to Healthcare Professional and member – Written letter / E-mail.

• Reconciliation of all claims received and captured on the Nexus system.

• Perform weekly and monthly statistics in Excel.

• Telephonic contact with members and Healthcare Professionals daily.

• Seven months Medscheme Customer Services Consultant (Walk-in Centre).

• Liaise with Principal Officer and Committee members on different Schemes.

• Prepare Ex Gratia cases Glossary.

• Attend Committee meetings.

4

• Perform product knowledge assessments monthly as required to show good knowledge of different schemes Annexures.

Reason for leaving: To join my husband as an Estate Agent in the Property Sales Market. MEDSCHEME REFERENCE:

Sunelda Gravett

(011) 758- 8766

adl4f5@r.postjobfree.com

Ms Zelda Duckitt

(021) 466- 1305

adl4f5@r.postjobfree.com

Name of Company:

PGBI ENGINEERS AND CONSTRUCTORS (Pty)

Period: 1 April 1995 – September 1995

Receptionist:

Responsibilities:

• Supervision of the reception area.

• Interaction with visitors.

• Control deliveries,

• Operate the Switchboard.

• Distribution of messages.

• Manage boardroom bookings.

• Ensure that reception equipment operates efficiently. Reason for leaving: Relocated.

Name of Company:

GRANDIFLORA

5

Period: 3 July 1990 – March 1995

Position: Receptionist:

Responsibilities:

• Switchboard.

• Secretary to Management.

• Telephone orders.

• Petty cash.

• Cashing – up.

• Client Services, Client Liaison.

• Public Relations and General Administration.

• Assisted the floor manager at Grandiflora and participated in the layout of shop decorations for five years.

Reason for leaving: Confinement.

Contact this candidate