Belinda Meth
Brakpan
Summary
Claims quality assurance consultant with extensive experience in claims processing and validation at Renasa. Strong analytical skills and attention to detail drive compliance and operational efficiency. Expertise in fostering team collaboration and delivering actionable insights leads to significant improvements in claims management.
Overview
22
22
years of professional experience
Work History
Claims Quality Assurance Consultant
Renasa
06.2016 - Current
- Efficiently capture claims on ROC and Oscar systems, ensuring accurate and timely input of information.
- Authorize claims within the ROC system, utilizing analytical thinking to ensure accuracy.
- Validate claims through the QA dashboard, approving claims within the set mandate, and referring claims exceeding the mandate for further approval.
- Communicate requirements or necessary amendments to Project Managers (PM) or Underwriters (UW) based on claim assessments.
- Validate claims against established checklists and possess extensive knowledge of policy wordings, employing this understanding to ensure claims compliance beyond checklist parameters.
- Provide weekly savings estimates while monitoring and assessing the impact of claims on a regular basis.
- Demonstrate a deep understanding and extensive knowledge of policy wordings to accurately assess and process claims.
- Handle various ad-hoc tasks that may arise, requiring flexibility and adaptability within the role.
Quality Assurance Specialist
Old Mutual IWYZE Valuable Insurance
03.2011 - 05.2016
- Regularly listen to and evaluate calls across different departments such as Sales, Quotations, Claims, Client Service, and Retentions to ensure adherence to quality standards.
- Provide coaching and constructive feedback to agents based on call evaluations, aiming to improve their performance and adherence to protocols.
- Conducted live assessments of calls to provide immediate feedback and support.
- Analyzed call data to identify trends and provide actionable insights for process improvement.
- Participate in calibration sessions with teams to ensure consistency and alignment in evaluation methods and standards across assessors.
- Monitored and identified potential risks and fraudulent activities within sales, ensuring adherence to compliance and ethical standards.
- Investigate cases related to fraudulent sales or claims, gathering evidence and providing insights for resolution.
- Managed month-to-month commissions, ensuring accuracy and compliance with established guidelines to support financial integrity.
Claims Assessor | Validations | Data Capturer | New Business Quality Consultant
Sanlam Sky | Channel Life (Merged)
08.2006 - 02.2011
- Assessed claims and resolved outstanding requirements for funeral policy documents.
Generated daily and weekly reports to monitor claim processing efficiency.
Managed error reports for policies not loaded onto the system.
Handled claim correspondence for closed or repudiated claims.
Communicated with clients, hospitals, and law firms to gather necessary documents for payment.
Provided support to internal clients regarding policy servicing and inquiries related to death claims.
Indexed and attached relevant documents for efficient record-keeping.
Authorized new business for commission runs in collaboration with brokers. - Reviewed documentation for accuracy and completeness in claims processing, contributing to reduced errors and improved service delivery.
- Collaborated with team members to streamline workflow, enhancing efficiency and reducing processing times.
- Assessed claims and resolved outstanding requirements for funeral policy documents.Generated daily and weekly reports to monitor claim processing efficiency.Managed error reports for policies not loaded onto the system.Handled claim correspondence for closed or repudiated claims.Communicated with clients, hospitals, and law firms to gather necessary documents for payment.Provided support to internal clients regarding policy servicing and inquiries related to death claims.Indexed and attached relevant documents for efficient record-keeping.Authorized new business for commission runs in collaboration with brokers.
Call Centre Team Leader
SA Call Centre
04.2005 - 07.2006
- Consistently monitor staff levels and liaise with management regarding any adjustments required
on the campaigns we were allocated
Actively participate in performance appraisals on a monthly basis
Consistently monitor systems with a view to recommending changes /Updates to improve them from the campaign managers
Assist in the management of staff rosters to meet anticipated business requirements to the agreed standards (retirement annuities)
Excellent customer service skills and meeting the client’s needs
Outsourced insurance products for Channel Life and PSG
Outbound cold calling - Monitored call metrics to identify trends and improve team efficiency.
- Trained new team members on call handling procedures and customer service skills.
- Consistently monitor staff levels and liaise with management regarding any adjustments required on the campaigns we were allocated Actively participate in performance appraisals on a monthly basis Consistently monitor systems with a view to recommending changes /Updates to improve them from the campaign managers Assist in the management of staff rosters to meet anticipated business requirements to the agreed standards (retirement annuities) Excellent customer service skills and meeting the client’s needs Outsourced insurance products for Channel Life and PSG Outbound cold calling
In and Outbound Debt Collector
Van Der Venter and Mojapelo Attorneys
01.2004 - 03.2005
- Negotiating payment options with clients to pay their outstanding accounts and following up on clients that have paid; as a reminder to do so every month until the account is settled
Capturing accurate details of clients to have their accounts debited
Soft tracing clients that have invalid contact numbers and establishing valid addresses - Communicated with clients to negotiate payment plans and resolve disputes.
- Negotiating payment options with clients to pay their outstanding accounts and following up on clients that have paid; as a reminder to do so every month until the account is settled Capturing accurate details of clients to have their accounts debited Soft tracing clients that have invalid contact numbers and establishing valid addresses
- Documented client interactions and updates in case management software to maintain accurate records.
Education
Risk and Fraudulent Training -
Alumni Talent
01.2014
Regulatory Exams RE – Representative 5 -
FBI
01.2012
National Certificate in Wealth Management NQF Level 5 -
PSG Konsult Academy
01.2010
Travel and Tourism -
Rosebank College
01.2002
National Senior Certificate -
Missouri Senior Secondary
01.2000
Skills
- Microsoft Word, Excel, and PowerPoint
- Internet proficiency
- Email communication
- Attention to detail
- Analytical thinking
- Ability to work under pressure
- Decision making
- Deadline driven
- Leadership
- Organizational skills
- Self-motivation
- Team collaboration
- Time management
- Interpersonal skills
- Problem solving
- Claims processing and validation
- Comprehensive assessment and reporting
- Policy expertise
References
Available on Request
Languages
- Afrikaans
- English
- Afrikaans
Timeline
Claims Quality Assurance Consultant
Renasa
06.2016 - Current
Quality Assurance Specialist
Old Mutual IWYZE Valuable Insurance
03.2011 - 05.2016
Claims Assessor | Validations | Data Capturer | New Business Quality Consultant
Sanlam Sky | Channel Life (Merged)
08.2006 - 02.2011
Call Centre Team Leader
SA Call Centre
04.2005 - 07.2006
In and Outbound Debt Collector
Van Der Venter and Mojapelo Attorneys
01.2004 - 03.2005
Risk and Fraudulent Training -
Alumni Talent
Regulatory Exams RE – Representative 5 -
FBI
National Certificate in Wealth Management NQF Level 5 -
PSG Konsult Academy
Travel and Tourism -
Rosebank College
National Senior Certificate -
Missouri Senior Secondary