Puleng Serobe

• Follow procedures and cooperate with peers and leader for best possible service delivery.
• Operational risk and governance structures, measures and frameworks are complied with, and necessary action is taken to address issues, when necessary.
• Defined legal, statutory, and regulatory compliance is maintained at the required standards.
• Processing and executing Broker Appointment within turnaround time, Producing contracts for New Brokers.
• Validate and capture Brokerage and Broker Agents Accreditations as per Council of Medical Schemes (CMS).
• Assisting Brokers with Commissions Payment Queries.
• Creating and loading SUB code under House Code as requested by KI or Principal Broker.

• My role as a Back office agent is to respond to emails from members within the agreed timeframe
• Assisting with team escalations and complaints telephonically or via email
• Making outbound calls to obtain more information from members or further clarify on queries received
• Reconciliation and investigation of claims and providing feedback on why claims were rejected or not paying
• Capturing of claims
• Create hospital authorizations requests
• Allocate payments, lift suspensions and create Recon statements
• Handle escalations of complex calls within the correct divisions
• Amending customer details, addition of dependents on the system, changing bank details.
• Capturing new claims, reprocessing claims and ensuring that claims were paid from the correct benefits as per the ICD 10 codes linked.
• E-mail correspondences comply with standards procedures
• (Bonitas Medical Fund)

• Broker support by attending to enquiries
• (Hosmed Medical Scheme)
• Developed strong relationships with clients, earning their trust and loyalty through consistent communication and portfolio updates.
• Developed a reputation for integrity and ethical conduct within the brokerage community, leading to increased trust from clients and colleagues alike.
• Provided exceptional customer service, addressing any concerns or questions from clients promptly and professionally.
• Recorded supporting documentation for phone calls and written correspondence.
• Prepared contracts and related documentation according to strict standards.

• Providing broker training to improve product knowledge.
• Broker support by attending to enquiries.
• Broker support team internal QC, weekly & monthly broker Reports.
• Developed strong relationships with clients, earning their trust and loyalty through consistent communication and portfolio updates.
• Provided exceptional customer service, addressing any concerns or questions from clients promptly and professionally.

• Set performance expectations for the team, monitoring progress towards goals and providing constructive feedback as needed.
• Developed team members'' skills through targeted coaching sessions, resulting in improved individual performance.
• Enhanced team productivity by implementing efficient work processes and regularly reviewing performance metrics.
• Empowered team members by delegating responsibilities according to individual strengths and areas of expertise.
• Managed conflict resolution among team members, fostering a positive and collaborative work environment.
• Established open and professional relationships with team members to achieve quick resolutions for various issues.
• Increased customer satisfaction ratings by closely monitoring service quality standards and addressing any issues promptly.

• Member and Provider email queries
• Prioritized high-priority tasks effectively leading to increased workplace efficiency.
• Gathered records pertinent to specific problems, reviewed for completeness and accuracy and attached records to correspondence as necessary.

• Delivered exceptional customer service by proactively addressing concerns and fostering a positive experience throughout all interactions.
• Assisted clients in navigating the claims process, ensuring timely resolution of issues and optimal outcomes.
• Enhanced client satisfaction by promptly addressing inquiries and providing accurate information on products and services.

• Agents Call Quality Assessing
• Monitoring Calls: Listening to recorded calls or observing live ones to assess agent performance.
• Evaluating Interactions: Using a scorecard to rate agents on aspects like politeness, accuracy of information, and problem-solving skills.
• Feedback and Coaching: Providing constructive feedback to agents based on evaluations and guiding them toward improvement through coaching sessions.
• Process Improvement: Identifying opportunities to refine existing call center processes and improve customer experiences.
  
  

• Initiating contact with debtors through phone calls, emails, or letters to discuss overdue payments.
• Negotiating payment plans that align with the debtor's financial situation.
• Providing excellent customer service to ensure a positive experience for both the agent and the debtor.

Initiating contact with debtors through phone calls, emails, or letters to discuss overdue payments.
Negotiating payment plans that align with the debtor's financial situation.
Providing excellent customer service to ensure a positive experience for both the agent and the debtor.