Bianca Ngwenze

Effective coordination of the end-to-end policy claims process

Register, validate and process claims according to policy conditions, benefits and business rules, manually or electronically, for all practice types, i.e., General or dental practitioners, pathology, radiology, and hospital claims.

Demonstrate extensive knowledge of ICD 10 codes, medical procedures, and medical aid schemes

Demonst

New Business Support
- Sending forms and questionnaires for medical aid, primary care, gap cover and broker appointment applications.
- Loading and tracking new business leads on CRM platform (MS Dynamics 365 within stipulated turn-around-time
- Calling /emailing prospective clients to conduct online applications
- Sending welcome mailers with membership certificates, loading policies details

Effective coordination of the end-to-end policy claims process

Register, validate and process claims according to policy conditions, benefits and business rules, manually or electronically, for all practice types, i.e., General or dental practitioners, pathology, radiology, and hospital claims.

Demonstrate extensive knowledge of ICD 10 codes, medical procedures, and medical aid schemes

Demonst

Scope of Responsibility:
 
• Assess claims within the agreed service level agreement.

• Request outstanding information from clients (telephonic & e-mail).

• Ensure that claims are processed according to the rules, benefits, and conditions of the policy.

• Contact service providers for discounts when claims are over the company prescribed threshold.

• Ensure that all policy limitations, waitin

• Servicing all key stakeholders telephonically and via other servicing channels as required until the query has been resolved

• Servicing our members in a customer centric way to ensure that we live by our service principles

• Keeping up to date with product changes to ensure that all key stakeholders are accurately serviced

• Continuously staying abreast of all digital servicing tools with

• Daily assessing and manual capturer of paper or image claims
• Collection, completion and returning of batches
within stipulated service level agreement times
• Achieving of daily target on claims capture
• Ability to analyze data
• Demonstrating high level of attention to detail and accurate capturing speed

• Capturing of New Business applications with a high
level of accuracy and speed, efficiently into paradigm.
• Performing data scrubbing and bulk uploads and to
ensure that all information captured by the data
capturers is accurate.
• Working according to Pinpoint standards and
protocols.
• Working towards a daily target with regards to quality
and quantity in order to ensure that Ser

Teaching English online as a 2nd additional language
to non – English students.
• Obtained a 120 hr. TEFL course certification.

Pursuing a Bachelor's degree in Financial Management.