Admin clerk
Resume:
PERSONAL PARTICULARS
Name: Zainab Arendse
Date of birth: 29.06.1983
ID: 830-***-**** 08 9
Nationality: Coloured
Home languages: English - Spoken & written
Afrikaans - Spoken & written
Health: Excellent
Marital status: Married
Dependents: Four
EDUCATION
High School: Cedar High, Grade 12
Subjects: English
Afrikaans
Biology
Business Economics
Economics
History
Tertiary Education: Intuition College 27-29 Heerengracht Tulbagh Square, C/T
Certificate
Introduction to MS Office
Ms Word
Excel
Windows
Computer Fundamentals
WORK EXPERIENCE
Employer: Samwumed
Period Employed: April 2019 – current
Position: Back Office Clerk\ 2IC Second in command
Primary function:
Loading authorization for Psychiatry, Physiotherapy, advanced dentistry, medical -appliances and external prosthesis.
Capturing and processing claims
Reprocessing of claims
Motivating exception cases and recommendations for ex-gratia
Responding to members/providers via emailed queries
Providing an action plan in the morning which contains the volume of work the team has and the dates.
Making sure the team remains within SLA (service level agreement)
Splitting the work to the team for the day
Testing of tariff amounts for the next benefit year.
Assisting call center agents with queries and navigation of the system.
Distribute emails received to the relevant department
Save/archive emails and related attachments to the member/provider's file in MIP
Attend to requests for documentation or certificates
Resolve all queries received other than the Call Centre
Attend to all queries received via mail, fax or email
Processing of authorisations
Preparation and processing of special cases (Stale claims, Motivations, PMB's etc.) cases as per protocol
Administration and processing of CMS complaints
Adjust claimed amounts, note codes and claim when requested by the claims assessors when an error was made by one of the assessors
Employer: Samwumed
Period Employed: August 2018 – March 2019
Position: Contact center Agent/ Walk in center agent
Primary function
Assisting members and providers telephonically.
Assist team leader and contact center agents with queries.
Rule testing for 2019
Call backs to irate members and providers.
Processing claims
Assist back office
Employer: Samwumed
Period Employed: December 2015 – March 2018
Position: Back Office Clerk
Primary function:
Loading authorization for Psychiatry, Physiotherapy, advanced dentistry, medical appliances and external prosthesis.
Capturing and processing claims
Reprocessing of claims
Motivating exception cases and recommendations for ex-gratia
Responding to members/providers via emailed queries
Providing an action plan in the morning which contains the volume of work the team has and the dates.
Making sure the team remains within SLA (service level agreement)
Splitting the work to the team for the day
Testing of tariff amounts for the next benefit year.
Assisting call center agents with queries and navigation of the system.
Distribute emails received to the relevant department
Save/archive emails and related attachments to the member/provider's file in MIP
Attend to requests for documentation or certificates
Resolve all queries received other than the Call Centre
Attend to all queries received via mail, fax or email
Processing of authorisations
Preparation and processing of special cases (Stale claims, Motivations, PMB's etc.) cases as per protocol
Administration and processing of CMS and Hello Peter complaints
Adjust claimed amounts, note codes and claim when requested by the claims assessors when an error was made by one of the assessors
Employer: Xpedient Medical
Period Employed: September 2014 – October 2015
Position: Credit control /Account Manager
Primary function:
Duties:
Receipting of payments received and doing journals
Correct billing errors made in Dr’s rooms
Submit claims to medical aid
Follow up on rejections
Follow up on short payments
Arrange payment plans for patients
Identify bad debt
Prepare accounts to be handed over to third party for collection
System: GoodX
Employer: Liberty Medical Scheme
Period Employed: December ’09 - August 2014
Position: Client service agent \Claims Assessor \ 2IC-Second in command
Primary function:
Confirming medical benefits, requesting Outstanding Docs.
Assisting with claim queries, forwarding queries to relevant departments
Helping with new applications. Updating with member information
All call center queries
Follow ups on unresolved queries
System Navigation
Premium Confirmation
To ensure first resolution and quality services
Correspondence (dealing with queries via webrt ),
Claims Assessing (capture and processing claims)
Assisting team leader with management escalations and other extra duties for the team 2IC of the team.(second in command)
Employer: IHS Health (Informed Healthcare Solution)
Period Employed: Sept’09 – Nov ‘09
Position: Brokers assistant
Primary function:
Sending new applications to various medical aids on behalf of Brokers
Sending requirements acceptance letters,counter offer letters and membership certificates
To members.
Basic admin duties for the directors as well.
Employer: Metropolitan Health Group
Period Employed: Sep 07 - Oct 08
Position: Call Centre Consultant
Primary function:
Confirming medical benefits, Requesting Outstanding Docs.
Assisting with claim queries, forwarding queries to relevant departments
Helping with new applications .Updating with member information
All call center queries
Follow ups on unresolved queries
System Navigation
Premium Confirmation
To ensure first resolution and quality services
Dealt with correspondence too
Employer: Metropolitan Health Group
Period Employed: Sep 07 - Oct 08
Position: Call Centre Consultant
Primary function:
Confirming medical benefits, Requesting Outstanding Docs.
Assisting with claim queries,forwarding queries to relevant departments
Helping with new applications .Updating with member information
All call center queries
Follow ups on unresolved queries
System Navigation
Premium Confirmation
To ensure first resolution and quality services
Dealt with correspondence too
Employer: Old Mutual
Period Employed: Aug’06 – Aug 07
Position: Call Centre Consultant
Primary function:
Dealing with various practices. Telephonic claims enquiries, Benefit confirmations, Membership confirmations, Authorizations for CT scans, MRI’s, Shortfall enquiries, Explaining Scheme rules and benefits, Attended to fax enquiries. Supplier Services Consultant / 9 schemes
Employer: Anthony Richards and Ass.
Period Employed: Oct ’05 – Aug ’06
Position: Call Centre Consultant & Relief Receptionist
Primary function:
Duties included tracing for Nedbank, members for surpluses owed by provident
Fund and pension funds. General admin duties, data capturing and debt collecting.
REFERENCES
Company: Samwumed
Name: Ronell Donough
Current Position: Team Leader
Telephone: 071-***-****
Company: Samumed
Name: Jodi Williams
Current Position: Team leader
Telephone: 021-***-**** / 073-***-****
Company: Xpedient Medical
Name: Carol Dixon
Current Position: Manager
Telephone: 021-***-****\ 071-***-****
Company: Liberty Health
Name: Merle Mengqane / Garth Koerisies
Current Position: Team Leader
Telephone: 021-******* /083*******
Company: IHS
Name: Stephen McPetrie \Richard Knowles\Mike Narun
Current Position: Directors
Telephone: 021-***-****
Company: Metropolitan Health Group
Name: Loretta Damon
Current Position: Team Leader
Telephone: 083-***-**** \ 021-***-****
Company: Old Mutual
Name: Avril
Current Position: Team Leader
Telephone: 021-***-****
Company: Anthony Richards and Associates
Name: Fouzila Abrahams \ Tania Hugh
Current Position: Team Leader
Telephone: 021-***-****
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