Mahlako Setlatjile
Quality Controller
Johannesburg
Summary
Presently I am employed as a Quality controller at Medscheme/ Afrocentric Health under the Fedhealth business unit. I briefly worked as a Membership specialist, Client Service agent and claims assessor. During this period, I have equipped myself with all administrative functions, which includes acting as an interface with clients, sourcing for clients, providing administrative support to the management. MS Office applications like Excel helped me in decent and organized representation of my administrative work. Possesses superior product knowledge to train and educate staff while maintaining optimal service and efficiency. Builds and maintains effective working relationships with internal and external customers.
Overview
11
11
years of professional experience
4
4
years of post-secondary education
Work History
Quality Controller: Membership
Medscheme
09.2023 - Current
- Ensure that all data processed is ISO (International Standards Organization) compliant and is implemented and maintained accordingly
- Compile monthly quality control schedule
- Apply Quality Analysis checklist to documents
- Identify incorrectly processed documents and return to be rectified
- When required, review IT generated review letters against rules of scheme
- Log call to report system error and follow up with IT
- Quality Analysis call stays open until resolved
- Defined legal, statutory and regulatory compliance is maintained at the required standards
- Operational risk and governance structures, measures and frameworks are complied with and necessary action is taken to address issues, when necessary
- Ensure that quality control targets are met as per the Service Level Agreements
- Meet delivery objectives through working with other team members within and linked to the department / project
- Resolve operational performance variations and problems and escalate unresolved issues to higher levels
- Ensure delivery targets/objectives are met and operate in a supportive manner to achieve successful delivery
- Engage in development, coaching and mentoring
- Support transformation through valuing diversity
- Behave in alignment with the Afrocentric values
- Keep up to date with operational changes implemented in response to important external influences
- Deliver in a manner that supports and meets operational quality standards and meets the defined departmental priorities.
Membership Specialist
Medscheme
05.2016 - 08.2023
- Accurately and efficiently data capture
- Answer member / scheme calls and provide relevant required information via relevant medium
- When required arrange for bulk new member / pay point registration files to upload onto system
- Keep members informed of the status of their requests
- Works with a team and assist in setting membership goals
- Identify prospects for membership and move prospects through the sales cycle
- Cultivate relationships with members that will support the growth of overall membership and the retention of current members
- Respond to requests for information, prepare letters, documents, forms, and respond to inquiries, and assist individuals in the membership application process
- Maintain current membership files
- Issue and assign membership cards, ensuring accurate information
- Receive applications, keep records of these applications and the date received, and ensured that the required documentation is submitted
- If necessary, request further information
- Keep accurate and up-to-date records (includes paper files, database), including records of births, deaths, reinstated members, and other additions or deletions of individual members
- Update and expand a secure membership database
- Professionally interact with members and applicants to address any questions
- Courteously assist the call Centre department when required.
Claims Assessor
Metropolitan Health Group
05.2014 - 04.2016
- Examine claims records and forms to determine whether the patient has medical insurance
- Negotiate claim settlements and make recommendations for legal action
- Complete logs, reports, forms and records to properly document medical claims
- Reject or accept documentation, determine benefit due, and start the denial or payment process to resolve medical claims
- Adhere to all company policies, procedures and guidelines
- Ensure all claims information remains confidential
- Engage in continuing education and training opportunities when possible.
Client Services Agent
Metropolitan Health Group
05.2013 - 04.2014
- Answering phones from customers professionally and responding to customer inquiries and complaints
- Providing customers with the organization’s service and product information
- Processing forms, orders, and applications requested by the customers
- Communicate with current and potential clients via telephone, email, online chat, or social media
- Listen attentively to questions and concerns and respond promptly with a resolution according to company guidelines
- Maintain a courteous and calm manner at all times to de-escalate stressful situations
- Keeping records of customer interactions, transactions, comments, and complaints
- Identifying, escalating priority issues and reporting to the high-level management
- Routing inbound calls to the appropriate resources
- Completing call notes and call reports as necessary
- Managing administration, communicating and coordinating with internal departments.
Education
Diploma Retail Travel and Tourism -
Jeppe College
01.2011 - 01.2013
Certificate Galileo Mundus - undefined
Jeppe College
01.2011 - 01.2013
Moonstone - undefined
RE 5
01.2022 - undefined
Critical, Analytical, and strategic thinking in practice - undefined
University of Pretoria
05.2022 - 06.2022
Skills
Communication Skillsundefined
Accomplishments
- Best Client Service Clerk at metropolitan Health in 2015
- Certificate of Excellence “ Top Performer “ for month of September 2019
- Client service champion 2020/2021
References
- Godfrey Khoza, 084 572 2284
- Kabelo Mashishi, 078 388 7360
Timeline
Quality Controller: Membership
Medscheme
09.2023 - Current
Critical, Analytical, and strategic thinking in practice - undefined
University of Pretoria
05.2022 - 06.2022
Moonstone - undefined
RE 5
01.2022 - undefined
Membership Specialist
Medscheme
05.2016 - 08.2023
Claims Assessor
Metropolitan Health Group
05.2014 - 04.2016
Client Services Agent
Metropolitan Health Group
05.2013 - 04.2014
Diploma Retail Travel and Tourism -
Jeppe College
01.2011 - 01.2013
Certificate Galileo Mundus - undefined
Jeppe College
01.2011 - 01.2013
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