Nomathamsanqa Mpangeva
ASSISTANT DIRECTOR -COMPENSATION FUND
Rustenburg,NW
Summary
Dynamic and results-driven professional with extensive experience at Compensation Fund, excelling in claims assessment and processing. Recognized for reducing claim settlement turnaround time and enhancing operational efficiency. Strong communicator and collaborator, adept at leveraging computer skills and a positive attitude to foster teamwork and deliver exceptional customer service.
Pursuing full-time role that presents professional challenges and leverages interpersonal skills, effective time management, and problem-solving expertise.
Overview
17
17
years of professional experience
1
1
Certification
1
1
Language
Work History
Assistant Director
Compensation Fund
01.2024 - Current
- Self-motivated, with a strong sense of personal responsibility.
- Excellent communication skills, both verbal and written.
- Proven ability to learn quickly and adapt to new situations.
- Skilled at working independently and collaboratively in a team environment.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Worked effectively in fast-paced environments.
Senior Claims Assessor
Compensation Fund
06.2018 - 12.2023
- Consistently met or exceeded performance goals set by management, demonstrating commitment to excellence within the role of Claims Assessor.
- - Adjudicate registered and fatal claims per delegation`s requirements
- - Verify and refer complex claims to Medical Services for further adjudication
- - Authorise compensation benefits as per delegations
- - Handle complex enquiries and advocacy sessions
- Verify TTD claims and PDprepared by the team before they capture on system
- Authorise claims captured
- Reduced turnaround time for claim settlements by prioritizing tasks, effectively managing caseloads, and collaborating with cross-functional teams.
Medical Claims Processor
Compensation Fund
12.2015 - 05.2018
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and Government Gazette.
- Followed up on denied claims to verify timely patient payment and resolution.
- Paid or denied medical claims based upon established claims processing criteria.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Monitored and updated claims status in claims processing system.
Medical Claims Processor
Metropolitan Health Group
01.2009 - 11.2015
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures
- Managed large volume of medical claims on daily basis.
- Identified and resolved discrepancies between patient information and claims data.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Reviewed provider coding information to report services and verify correctness.
- Handled escalated claims-related issues professionally, working diligently towards resolution while maintaining strong relationships with both clients and providers alike.
- Identified opportunities for process improvements within the claims department, leading to increased overall efficiency and reduced costs associated with claim reworkings.
- Maintained a thorough understanding of the intricacies involved in processing medical claims for diverse healthcare specialties, enabling accurate and efficient claim adjudication.
Education
Bachelor of Arts -
Stellenbosch Univeristy
Cape Town 04.2001 -
High School Diploma -
Cape Peninsula University of Technology
Cape Town 04.2001 -
Skills
Friendly, positive attitude
Certification
IELETS
Timeline
Assistant Director
Compensation Fund
01.2024 - Current
Senior Claims Assessor
Compensation Fund
06.2018 - 12.2023
Medical Claims Processor
Compensation Fund
12.2015 - 05.2018
Medical Claims Processor
Metropolitan Health Group
01.2009 - 11.2015
Bachelor of Arts -
Stellenbosch Univeristy
04.2001 -
High School Diploma -
Cape Peninsula University of Technology
04.2001 -
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