Names : Kgosi David Surname : Mochubi Cell phone Number : 0670767913 Date of Birth : 10 November 1996 Gender : Male
Kgosi David Mochubi
Claims Administrator
Johannesburg
Summary
Claims specialist with strong focus on resolving issues efficiently and delivering results. Adept at managing complex claims processes, analyzing data, and ensuring compliance with regulations. Known for excellent teamwork and adaptability in dynamic environments. Skilled in customer service, communication, and problem-solving, consistently contributing to organizational success.
Overview
6
6
years of professional experience
4
4
years of post-secondary education
2
2
Languages
Work History
Claims Administrator
Alexander Forbes
- Attend to communication by correspondence or telephone on claims matters with members, and other necessary persons and/or bodies.
- Evaluate claim documentation and information to ensure the validity of a claim and the banking details of a member's account.
- Prepare information for the financial year end of your funds
- Direct /indirect housing loans where applicable
- Take responsibility for valid changing of member details on behalf of the team
- Process all ROTs (Recognition of Transfer i.e., transfers to other funds) if required
- Attend to and resolve all issues related to payments being rejected, AVS's and tax rejections to be resolved.
- Deal with problematic clients to the resolution of the query/issue.
- Attend to all e-mails and written correspondence.
- Attend to telephonic queries from members.
- Work together as a team by regularly updating comments, regular follow-up of pending, and assisting colleagues if needed.
- Attend to queries or inquiries by members within the required timelines
- Help Employers or service providers where necessary
- Escalate complicated queries to the Team Leader
- The completion of Administration Reports
- Receive and take responsibility for the timeous workflow and processing of all claims
- Quality assurance of claims documents received, as per the work instruction.
- Sending out of communication of claims correspondence, inclusive of attachments
- Correctly administer claim documents and claim correspondence as per the published work instruction
Client Services
Motor Industry Fund Administrators (MIFA)
08.2022 - Current
- Attend to all e-mails and written correspondence.
- Attend to telephonic queries from members.
- Regular follow-up of pending queries.
- Verify member's identity.
- Check member's status on Everest.
- Send SMS or email when a written response is required, when documents must be sent to the caller or when the caller must submit documents.
- Attend to customer needs on the phone, update records on the system, take notes, and complete other post-call duties.
- Diarize when to follow up on claim and to provide feedback to the member.
- Effectively assists caller/ enquirer within the SLA.
- Prompt answering of the switchboard/incoming calls
- Cultivate and maintain positive relationships with clients.
- Stay informed about industry developments and trends through self-education.
- Respond to allocated emails within 24 - 48 hours with the appropriate response
- Timeous & Accurate client and member communication in line with company and branch procedures and control
Claims Administrator
Motor Industry Fund Administrators (MIFA)
02.2020 - 04.2022
- Evaluate claim documentation and process accurate calculations of all valid claims.
- Assess claim documentation, communicate any QA Failure (Quality assurance) to Member/ Employer/ MIBCO within 24 hours of receipt.
- Apply for bank validation & tax within 48 hours of receipt of claims.
- Process claim, generate R.O.T & send to broker within 72 hours of receipt of claim.
- Follow up weekly for outstanding Recognition of Transfer forms from broker/s
- Ensure Proof of Payment, payment letter and benefit breakdown are sent to broker and member within 24 hours of claim being authorised.
- Ensure compliance with the principles of Treating Customer Fairly (TCF)
- Respond to customer email queries with 24hrs of receipt.
- Respond to telephonic queries immediately and resolve the query where possible, if not ensure the customer is provided with a timeline for a resolution.
- Apply for tax within 24 hours of receipt of signed Recognition of Transfer form from broker.
- Authorise payment of valid claims within 72 hours turnaround time
- Identify and contribute to ongoing process enhancement
- Weekly, Monthly, Annual, Bi-Annual, Quarterly reporting across all admin processes and systems
- The completion of member Statements (where applicable)
- Assists in times of absenteeism/pressure to ensure work delivery
- Balanced workload effectively, prioritizing tasks to ensure timely completion of all claim-related responsibilities.
- Ensured timely claim payments by diligently monitoring deadlines and following up on outstanding documents.
- Managed a high volume of daily claims, consistently meeting deadlines without compromising attention to detail or accuracy.
Education
Diploma - Business Management
South West Gauteng College TVET
01.2016 - 01.2017
P.J Simelane High School
01.2011 - 01.2012
Office Administration
South West Gauteng TVET College
01.2013 - 01.2015
Skills
- Customer service
- Customer communication
- Adaptability
- Teamwork
- Communication
- Customer service
Interests
Accomplishments
- Resolved product issue through consumer testing.
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Collaborated with team of fourteen in the development of claims processing project.
References
Mrs, Phukubye, Teacher, 086 176 8849, Southwest Gauteng TVET College
Mrs Nomithi Mafu,Manager,011 269 0058, Alexander Forbes
Mr Boyboy David Modise, Specialist, 011 269 0058, Alexander Forbes
Baleseng Masela, Senior Administrator, 011 561 9340, MIFA
Luke Le Cordier, Manager, 011 561 9300, MIFA
Timeline
Client Services
Motor Industry Fund Administrators (MIFA)
08.2022 - Current
Claims Administrator
Motor Industry Fund Administrators (MIFA)
02.2020 - 04.2022
Diploma - Business Management
South West Gauteng College TVET
01.2016 - 01.2017
Office Administration
South West Gauteng TVET College
01.2013 - 01.2015
P.J Simelane High School
01.2011 - 01.2012
Claims Administrator
Alexander Forbes
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