Anneline Sophia Verwey
Gap Claims Specialist
Durban
Summary
Detail-oriented Claims Specialist with advanced skills in claims processing, regulatory compliance, and documentation accuracy. Proven track record of resolving member inquiries efficiently, enhancing satisfaction and retention.
Dedicated, with over a decade of experience in the insurance sector. Expertise in problem analysis and data entry, contributing to accurate claims settlements and improved member communication. Committed to delivering exceptional customer service and ensuring regulatory compliance.
I have a strong record in handling and resolving complex claims efficiently. Adept at analyzing data, identifying discrepancies, and providing solutions that drive positive outcomes. Skilled in negotiation, customer service, and regulatory compliance, consistently ensuring accuracy and fairness.
Overview
14
14
years of professional experience
Work History
Claims Specialist
Nhluvuko/African Unity Health/Kaelo
07.2014 - Current
- In 2015 Nhluvuko (PSG gap) was taken over by African Unity and then again by Kaelo in 2018. I have been with the business since 01/03/2012 and have kept the years of service with the company with each take over.
- Analyzed and processed insurance claims efficiently to ensure accurate settlements, reducing corrections and ensuring customer satisfaction.
- Contacted members for outstanding requirements, clarifying needs and guiding document procurement process.
- Trained new recruits on product knowledge and system navigation, enhancing onboarding experience.
- Assisted in generating reports from the system during management absence, providing colleagues with daily expectations.
- Updated system with provider details to ensure data completeness. in the event that the practice was not yet captured on the system
Member Support Consultant
PSG
03.2012 - 02.2024
- Resolved member inquiries and issues promptly, improving satisfaction and retention through effective communication and problem-solving.
- Assisted members with complex inquiries, boosting satisfaction and retention through efficient problem-solving and personalized support at PSG.
- Analyzed client requirements to provide tailored support solutions.
Claims Loader
PSG/Nhluvuko
03.2014 - 06.2014
- Executed loading of claims into PSG's gap cover system Nhluvuko to ensure data availability for processing.
- Input and verified large volumes of insurance claims data to ensure timely processing and minimize errors in claims management.
- Uploaded insurance claims data into PSG/Nhluvuko’s system, ensuring accuracy and timely validation to facilitate prompt claims settlement.
Education
Certificate in Wealth Management Medical – NQF 5 - Wealth Management And Medical
Moonstone School of Excellence
Westville - South Africa 04.2001 -
Skills
Customer service
Data entry
Claims processing
Problem analysis
Conflict resolution
Regulatory compliance
System navigation
Documentation accuracy
Empathy
Timeline
Claims Specialist
Nhluvuko/African Unity Health/Kaelo
07.2014 - Current
Claims Loader
PSG/Nhluvuko
03.2014 - 06.2014
Member Support Consultant
PSG
03.2012 - 02.2024
Certificate in Wealth Management Medical – NQF 5 - Wealth Management And Medical
Moonstone School of Excellence
04.2001 -