Avela Maqoga
Cape Town
Summary
Dedicated and results-driven customer service professional with 6 years of extensive experience, including 4 years in the specialized field of managed care. Proven track record of delivering exceptional service and building strong relationships with clients. Currently in the final semester of a Diploma in Public Relations, combining practical expertise in customer relations with strategic communication skills. Adept at navigating complex issues, problem-solving, and ensuring client satisfaction. Eager to leverage my comprehensive background in both customer service and public relations to contribute effectively to a dynamic and forward-thinking team.
Overview
7
7
years of professional experience
Work History
Pre-authorization Consultant
Momentum Health
12.2020 - Current
- Developed innovative strategies that resulting in making work more efficient and affected our members interactions more positively
- Streamlined internal processes to enhance team efficiency.
- Collaborated with cross-functional teams to successfully deliver comprehensive solutions for clients.
- Enhanced communication among team members, fostering a collaborative and supportive work environment.
- Identified areas of improvement for clients'' operations, implementing targeted solutions to increase productivity.
- Managed client relationships through regular check-ins and updates on pending authorization requests.
- Complied with POPI in verifying members and checking members eligibility to receive benefits and funding.
- Medical claims processing. Prepared and submitted claims for services rendered and checking if proper coding has been done on claims for available benefits to be paid.
- Patient advocacy. educate members on their cover for benefits, possible shortfalls, copayments and deductible.
- compliance and regulation, staying within the current medical aid industry regulations.
Chronic Illness Consultant
Discovery Medical Scheme
08.2018 - 11.2020
- Generated reports detailing findings and recommendations.
- Patient empowerment, empower members to take an active role in managing their chronic conditions, fostering self managements skills and adherence to their treatment plans
- Assisted members, brokers and treating Drs with formulary medication for discovery health members.
- Liaised with Dr rooms to get necessary documentation required for review of patient medication.
- Patient advocacy, educated members on their chronic illness benefits and their respective treatment plans.
Customer Service Agent
Merchants Data Dimensions
01.2017 - 07.2018
- Reduced process inconsistencies and effectively trained team members on best practices and protocols.
- Met customer call guidelines for service levels, handle time and productivity.
- Streamlined communication processes for improved information exchange between customers and team members.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Assisted in training new hires, sharing best practices for effective customer service delivery.
Education
Public Relations And Organizational Communication
University of South Africa
Parow, South Africa06.2024
N4 in Tourism
Boland College
Stellenbosch, South Africa11.2014
High School Diploma -
Mpeko S.s.s
Mthatha, South Africa11.2011
Skills
- Customer service
- Communication
- Best Practices Implementation
- Delivery Assurance
- Client Engagement
- Team Leadership & Development
- Customer Relationship Management
- Problem-Solving
- Work Planning and Prioritization
- Computer skills (microsoft word,Excel,powerPoint and outlook)
- Attention to detail
Additional Information
Drivers license: Code B
Timeline
Pre-authorization Consultant
Momentum Health
12.2020 - Current
Chronic Illness Consultant
Discovery Medical Scheme
08.2018 - 11.2020
Customer Service Agent
Merchants Data Dimensions
01.2017 - 07.2018
Public Relations And Organizational Communication
University of South Africa
N4 in Tourism
Boland College
High School Diploma -
Mpeko S.s.s
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