nomfundo mbotheni

I’m a Customer Escalations Specialist who resolves complex member and client issues with speed, accuracy, and empathy—managing sensitive claims, benefits, authorisations, and service dissatisfaction while staying within SLA timeframes. In my current role, I act as a key liaison between members, healthcare providers, and internal teams (claims, clinical, and underwriting), interpreting scheme rules and claims processing outcomes to close disputes and prevent repeat failures.

Across my previous experience, I consistently improved customer outcomes: I helped increase customer satisfaction by 10% by strengthening resolution quality and investigated high-cost claims to detect inconsistencies and prevent potential fraud. I also bring strong regulatory and governance discipline—handling Section 14 transfers in line with Pension Funds Act and FSCA requirements, maintaining compliant case records and audit trails (including POPIA), and applying TCF principles to resolve complaints professionally while supporting retention strategies.