High School Code 8
Resume:
Roxanne
Arumugam
South African Female: ID 860-***-**** 086
Randburg, 2188
***************@*****.***
Code 8
Objective
Strong planner and problem
solver, who readily adapts to
change, works independently,
and exceeds expectations with
the ability to juggle multiple
priorities and meet tight deadlines
without compromising quality.
Seeking a challenging position
that will utilize years of work
experience and superior skills.
Computer Skills
• Ms Word
• Ms Excel
• Ms PowerPoint
• Ms Outlook
• Google Drive
• Internet
Language Skills
• English
Personal Skills
• Attention to Detail
• Analytical Thinking
• Ability to Work Under Pressure
• Communication Skills
• Decision Making Skills
• Deadline Driven
• Leadership Skills
• Organizational Skills
• Self Motivated
• Teamwork
• Time Management
• Systematic
• Interpersonal Skills
Academic Experience
COIDA (NQF5), UNISA
National Senior Certificate,
Reservoir Hills High School
2003
References
Employment History
November 2019 to Present
Constantia Group (Bryanston), Claims Investigator
● Manage the entire CLL portfolio.
● Responsible for all activities pertaining to funeral 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
● Auditing claims of our partners (Insure Africa).
● Keeping up to date with red flag doctors and funeral parlors
● Follow up of outstanding requirements with claimant as required to finalize 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
● Processing monthly claims reports and Dashboards for management
● Processing of claim payments
● Policy administration on all policies
● Finalization of claims
● Sending out monthly client statements and correspondence
● Updating all outgoing correspondence on the system.
● Batch capturing policy holder premium payments from the corporate account to the Profida system
● Capturing new beneficiaries / bank account information and policies
● Involved with aspects of a section 50 transfer
● Compiling training presentations and training staff on the various products
● Attendance at monthly MANCO meetings
● Review and enhance claims policies and documentation where necessary.
● Assisting with telephonic claim policy and claim related queries
● Verify the validity of the death, disability, and terminal illness.
● Investigate claims in terms of the policy terms and conditions.
● Identify fraudulent claims, doctors, funeral parlors etc.
● Compile and draw up letters to clients, Hospitals and Doctors.
● Draw up Standard Operating Procedures. Update risk and covid register.
● Various data handling and extracting data for reporting.
● Arrange document archiving in the department.
● General claims assistance and business management.
● Ability to work independently and to carry out assignments to completion and negotiate.
● Handle all policy or claim related queries and complaints timeously and efficiently.
● Follow up on repudiation, payment, and pending reports.
● Periodic reporting to finance and line manager on all payments made.
● Extract data.
● Ensure clients are treated fairly by TCF.
● Draw standard operating procedures and policies.
● Investigate claims until conclusion leading to decline or approval.
● Analyze, identify, and investigate unusual claims.
● Follow up on repudiation, payment, and pending reports.
● Periodic reporting to finance and line manager on all payments made.
● Compile comparison reports.
● Extract data for the actuarial month reports.
April 2011 to April 2018
FEM, 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.
● Duplicate checking of documents.
● 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.
Karabo Mauone FEM (082 320
1683
Michele Barclay Constantia
Insurance 082-***-****
● Full internal claims Assessor training (Coida Act 1993)
● Full knowledge of ICD 10 codes
● Payment of medical accounts
● Refunds to the employee and employer.
● Follow up on treatment plans and medical procedures
● Requesting medical reports from service providers/specialists
● Assisting injured employees with follow up appointments to ensure their treatments are finalized.
● Follow up on outstanding medical reports
● Calculating Permanent disability awards to pay out to injured employees based on the medical reports from the specialist or general practitioner.
● Calculation of temporary total disablement
● Calculating monthly wages according to the COID ACT
● Estimating the total cost of a claim.
● Finalization of claims
● Filing, Faxing, Emailing, etc.
April 2011 to April 2018
FEM, Medical Claims Assessor / Insurance
Contact this candidate