Lindelwa Mngomezulu
Randpark Ridge
Summary
I have recently been informed of a new position available at your company and I wish to submit my application. I have years of experience in the Insurance industry, handling Disability, Pension and Permanent Incapacity claims. I have worked both with Individual and Group benefits, as well as in the medical aid scheme setting. I also have years of experience in administration and with client relations. Throughout my career, I have often attended courses in claims assessments and other related subjects in order to keep up-to-date with the latest methods and technologies available to carry out my tasks in providing effective and efficient service to my clients and stakeholders. Your consideration of my application would be greatly appreciated and I look forward to hearing from you. For any further details or references, do not hesitate to contact me.
Overview
17
17
years of professional experience
Work History
Senior Permanent Incapacity Assessor
PPS Insurance
11.2017 - Current
- Assess all claims consistently and decide on their validity.
- Provide clients with the necessary correspondence regarding the claim decision and review requirements.
- Liaise with the relevant role players for claims needing active management.
- Ensure claims are reviewed on time.
- Keep relevant records and update existing systems and other spreadsheets to ensure that claims analysis can be performed.
- Visit clients requesting direct contact and active management of claims.
- Liaise regularly as requested with brokers and their clients to discuss relevant claims issues and resolve any outstanding queries.
- Provide medical interpretation and opinion regarding Permanent Incapacity awards.
- Partake in Medical Officers Committee meeting.
- Ensure that good knowledge of the policies, terms and conditions and their application is maintained.
- Ensure claims standards are met relative to policy wording, market.
- Assist in the development of processes to continually improve claims assessment standards.
- Handle client communication in a professional and diligent fashion.
- Ensure that all medical accounts are approved and forwarded for payment on receipt of the account and report.
- Ensure that all “rehabilitation” and “return to work” cases are dealt with on time and followed up.
- Communicate with the Consultant / broker / client regarding outstanding queries, either verbally or in writing, to obtain full and accurate information.
Claims Assessor
Rand Mutual Assurance
11.2013 - 11.2016
- Data Capturing
- Assessment and Adjudication of Injury on Duty Claims in terms of:
- Injury sustained
- ICD 10 Codes
- Medical Report capturing
- Medical Invoice Assessing and payment
- Temporary Total Disablement Payments
- Assessment of Impairment
- Lump Sum Payments
- Implementation of Disability Pensions
- Liaison with Role players
- Member Visits
- Telephonic Queries
- Walk-in Queries
- Interaction with Medical Service Providers
- Providing excellent written and verbal claim reports and follow ups
- Collation of medical reports
- Implementation of Fatal Pensions
- Filing & Archiving
- Providing claims reports to Management
- Submission of complex claims for Claims Committee Review
- Case Management of Claimants with the aim for Facilitating Rehabilitation that will result in Return to work
Administrator: Oncology Disease Risk Management
Momentum Health Risk Management
07.2010 - 11.2013
- Providing authorization of treatment plans to members on the oncology program.
- Liaising and networking with providers around the country in the management of clients’ treatment
- Managing client benefits and limits through-out the course of treatment and yearly.
- Providing feedback & research to disease manager on Oncology related queries and requests.
- Assisting with system development and providing ideas to possibly beneficial changes
- Liaising with scheme/fund managers to motivate to for PMB and/or related funds as well as
- Assisting other parts of the business with related queries and requests
- Working numerous different systems allocated to provide clients with access to benefit funds.
- Providing feedback to system developers on problems encountered and provide innovative ideas and solutions.
Client Services Agent
Momentum Health Scheme Administrators
08.2008 - 06.2010
- Taking phone call queries related to claims; membership, chronic medication and general medical aid issues
- Conducting Investigations
- Writing Correspondence: system letters
- E-mailing of Correspondence
Education
Bachelor of Social Science - Clinical and Industrial Psychology
University of Kwa-Zulu Natal (UKZN)
01.2008
Senior Certificate - undefined
Grosvenor Girls High School
01.2004
Skills
- Handling of critical and confidential information
- Report writing and presentation skills
- Communication (written and oral), interpersonal and networking skills
- Planning, organizing and time management skills
- Problem solving, analytical and innovative thinking
- Leadership and Project management skills
- Research skills
- Ability to work under pressure and adhere to deadlines
- Working in a team environment
- Training and sharing of knowledge
Languages
English
IsiZulu
IsiXhosa
References
Sbu, Zuma, Senior Manager – Disease Risk Management, 082 9718054, Metropolitan Risk Management, Disease Manager
Personal Information
- Date of Birth: 1986-12-17
- ID Number: 861217 0398 089
- Gender: Female
- Marital Status: Married
- Nationality: South African
Timeline
Senior Permanent Incapacity Assessor
PPS Insurance
11.2017 - Current
Claims Assessor
Rand Mutual Assurance
11.2013 - 11.2016
Administrator: Oncology Disease Risk Management
Momentum Health Risk Management
07.2010 - 11.2013
Client Services Agent
Momentum Health Scheme Administrators
08.2008 - 06.2010
Senior Certificate - undefined
Grosvenor Girls High School
Bachelor of Social Science - Clinical and Industrial Psychology
University of Kwa-Zulu Natal (UKZN)
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