Contact Details Customer Service
Resume:
Valerie Mashigo
**** ****** **** *** *, Soweto, *819
Landline: 073-**-***** ********@*****.*** Mobile: 083-******* Good Day,
Kindly find attached resume for the position advertised. My background of studying has given me Three years extensive vocation work experience as a claims technician in short term insurance for hospital cash back policies, making me very knowledgeable in medical terminology, identifying problems and ICD 10 coding.
In reviewing my CV you will establish that I have varied skills and ability to work with different types of people, I have excellent telephonic etiquette and communication skills and I believe I could fit easily into a team. I am a conscience person who is hard working and pays attention to detail, I am flexible and a team player, quick to pick up new skills and eager to learn from others. I am keen and enthusiastic to work for a company that a great reputation and high profile. Please take the time to read my resume which I believe you will find more than suitable for this role, I have excellent references and would be delighted to discuss any other possible vacancy with you at your convenience. I would also be grateful if you keep my CV on your database for any future possibilities.
Should you require any further information please do not hesitate to contact me. Kind Regards;
Valerie Mashigo
Enclosed: Resume
Valerie Mashigo Resume
Personal Details
Cell phone Number : 083*******
Home Number : 073*******
Email Address : ********@*****.***
Home Address : 5595 Protea Glen Ext 4
Soweto
1819
Nationality : South African (ID: 720**********)
Age : 45 (23th September 1972)
EE/AA Status : African Female
Career Summary
Company Position Duration
IFM Regional Medical Aid Customer Services Consultant October 1996-May 1999 Fedsure Health Group Customer Services Consultant June 2000-June 2001 Bensure Medical Aid Customer Services Consultant July 2001 to July 2002 MX Group Customer Services Consultant July 2002-July 2005 Metropolitan Health Group Customer Services Consultant November 2005-June 2006 Life Healthcare Group Filing, checking on once off payment July 2006-November 2006
Old Mutual Healthcare Customer Services Consultant January 2007 -february2009 Total Facilities Management
Company (TFMC)
Customer care May 2010 -October 2010
FNB Life Insurance Call Center Agent Jan 2011 - 30 August 2011 All Life insurance Underwriting 01 September 2011 - 31 January 2012
Prime Meridian direct Claim technician 02 February 2012 to December2016 Dr KJ Tlale Medical receptionist From 01 September 2017 to present
Employment
October 1996-may 1999 IFM Regional Medical Aid
Customer Services Consultant
Handling ambulance accounts
Logging and validating service providers’ accounts
Processing of claims
Reason for Leaving: To expand on my knowledge and to learn new skills and to also impart the knowledge that I have on to others
June 2000-June 2001 Fedsure Health Group
Redirecting calls to appropriate departments / medical aid schemes
Handling membership issues – registrations and terminations
Helping members and practices with medical claims
Making sure that accounts are paid promptly and accurately
Query resolutions from point of contact to conclusion.
Advising members on which options are suitable for them
Member education on how the medical aid industry operates.
Ensuring the smooth processing of medical accounts
(accurate referrals)
Liaising with different departments to ensure quality service.
Assisting members with financial issues like monthly contributions
Changing and updating of bank details and contact details
Capturing queries on Medware (in house system)
Checking the status of accounts on the Medware system
Doing call-backs on behalf of management / customer service
Assisting at the walk in centre (dealing with clients on a face to face basis)
Assisting with the training and induction of new employees to help them learn more about the industry.
Benefit confirmations.
Issuing of cheques to service providers
Reason for Leaving: Better prospects
July 2001 to July 2002 Bensure Medical Aid
Redirecting calls to appropriate departments / medical aid schemes
Handling membership issues – registrations and terminations
Helping members and practices with medical claims
Making sure that accounts are paid promptly and accurately
Query resolutions from point of contact to conclusion.
Advising members on which options are suitable for them
Member education on how the medical aid industry operates.
Ensuring the smooth processing of medical accounts (accurate referrals)
Liaising with different departments to ensure quality service.
Assisting members with financial issues like monthly contributions
Changing and updating of bank details and contact details
Doing call-backs on behalf of management / customer service
Assisting at the walk in centre (dealing with clients on a face to face basis)
Assisting with the training and induction of new employees to help them learn more about the industry.
Benefit confirmations.
Reason for Leaving: Not enough room for growth
July 2002-July 2005 MX Group Medical Aid
Processing chronic benefits applications
Sending remittances to service providers
Handling membership issues – registrations and terminations
Helping members and practices with medical claims
Making sure that accounts are paid promptly and accurately
Query resolutions from point of contact to conclusion.
Advising members on which options are suitable for them
Member education on how the medical aid industry operates.
Ensuring the smooth processing of medical accounts (accurate referrals)
Liaising with different departments to ensure quality service.
Assisting members with financial issues like monthly contributions
Changing and updating of bank details and contact details
Capturing queries on an in house systems
Checking the status of accounts on the system
Reason for Leaving: Not enough room for growth
November 2005-June 2006 Metropolitan Health Group
Benefit confirmations to service providers
Pre assessing accounts
Assessing of claims
Account enquiries
Making sure that accounts are paid promptly and accurately
Query resolutions from point of contact to conclusion.
Ensuring the smooth processing of medical accounts (accurate referrals)
Liaising with different departments to ensure quality service Reason for Leaving: Not enough room for growth
July 2006-November 2006 Life Healthcare Group
Filing, checking on once off payment
Doing call-backs on behalf of management / customer service
Processing of invoices
Sending of remittances to service providers
Query resolutions from point of contact to conclusion
Checking if new hospitals goods are received
Payment if is received
Reason for Leaving: Not enough room for growth
January 2007 –February 2009 Old Mutual Healthcare
Redirecting calls to appropriate departments / medical aid schemes
Handling membership issues – registrations and terminations
Helping members and practices with medical claims
Making sure that accounts are paid promptly and accurately
Query resolutions from point of contact to conclusion.
Advising members on which options are suitable for them
Member education on how the medical aid industry operates.
Ensuring the smooth processing of medical accounts (accurate referrals)
Liaising with different departments to ensure quality service.
Assisting members with financial issues like monthly contributions
Changing and updating of bank details and contact details
Capturing queries on system
Reason for Leaving: To expand on my knowledge and to learn new skills and to also impart the knowledge that I have on to others
May 2010 -October 2010 Total Facilities Management Company (TFMC)
Logging of customer requests
Conveying follow ups on
Previously logged requests
Handling of dispatches
For all applicable region
Updating the complaint report
Updating the VIP reports
Customer’s survey
Reason for Leaving: To expand on my knowledge and to learn new skills and to also impart the knowledge that I have on to others
Jan 2011 - to 30 August 2011 FNB Life Insurance
Update on funeral cover
Adding, deleting dependents
Redirecting calls to appropriate departments
Making sure that accounts are paid promptly and accurately
Query resolutions from point of contact to conclusion.
Advising members on which options are suitable for them.
Knowledge of short term insurance
Reason for leaving To expand on my knowledge and to learn new skills and to also impart the knowledge that I have on to others
01 September 2011 - to 31 January 2012 All Life insurance
Responsible for underwriting life, disability, dread diseases, sickness and permanent incapacity cover.
Underwrite cases within the agreed sla
Assess and authorize cases within underwriting to ensure accurate financial underwriting decision.
Sent to reinsurance treaties and placement authorities
Examine document to determine of health risk from such factors as health.
Review medical records to determine amount of insurance in force on single risk
Write medical personnel and others to obtain information, medical history explain company underwriting policies
Request pma reports from doctors
Have knowledge of short term and long term insurance Reason for leaving To expand on my knowledge and to learn new skills and to also impart the knowledge that I have on to others
02 February 2012- to December 2016 Prime Meridian direct
Handling either personal or commercial claims
Including injuries, accident, death claims
Liaising with insured party
Instructing loss adjusters/claim investigators
Ensuring a fair settlement for the client in the event of a claim
Communicating with both sides to insure that the client is Good service
Good service
Advising clients on insurance issues in general
Requesting hospital files, requesting reports from doctors
Liaising with medical aid
Assessing of claim, including motivation letter
Review of all information submitted in support of the claim against the applicable policy Terms & Conditions of cover.
Responsible for investigating and resolving all death and hospital assigned claims
Assess the claim duration of the admission, treatment given, test results, cause of admission and final diagnosis in order to validate the claim.
Ensuring claims are assessed in accordance to Company Standards for quality and service and ability to excel under pressure
Ensuring turnaround times are adhered to
Sturdy telephone etiquette and attention to detail
Requesting hospital files, requesting reports from doctors and good letter writing ability
Regular interactions with claimant to update them on the progress and outcome of their claims.
Reason for Leaving: Better prospects
01 september2017- to present Dr KJ Tlale
Answering of phones
Leasing with medical aids
Booking of patients
Attending to queries
Appointment confirmation with patients
Managing dairy and opening files
Maintaining files
Emailing and faxing reports
Data capture
Obtaining authorization from medical aid, confirm benefits
Booking theater lists
billings
Cash payments collecting outstanding payments
Experience with vericlaim system
Education
National Diploma Damelin (1996 -1997)
Communication 1
Statistics
Marketing Management
Accounting
Management
The community chest west rand (1998-1998)
Secretarial Certificate
Life Line Counseling Centre (2007)
Counsellor
Trauma Counseling
HIV and Aids issues
Rape, Abuse
Face To Face Counselling
Masentle High School (1993) (Lesotho)
English Language (B)
Sesotho (D)
Biology (B)
Commercial Studies (E)
Mathematics (B)
Biblical Studies (D)
References
Ms Eulanda Nkomo
Ms Diane Howell
Ms Annamarie Schoemann
Tel: 011*******
Ms Margie Ketho
Tel: 011******* Cell: 083292446
Mr Francois Brand
Tel: 011-******* ext 2171
Cell: 083*******
Ms Nicky Nicholson
Tel: 011-***-****
Johan Erwee (Claims Manager)
Cell: 079-***-****
Computer Literacy
Microsoft Office: MS Word, Excel, PowerPoint, Outlook, Internet Knowledge of in-house systems
Oracle system, IMED system, new med system, Medware and Sap system, ski, magnum, genre clue, Vertigo system.
Contact this candidate