Rushanta Pretorius
Benoni
Summary
Claims Administrator experienced in claims verification, customer relationship management, and dispute resolution. Enhanced client satisfaction through effective communication and problem-solving while ensuring regulatory compliance and accuracy in claims processing. Delivered efficient task completion and streamlined workflows to meet deadlines in fast-paced environments.
Overview
12
12
years of professional experience
Work History
Claims Administrator
Affinity Health | Benoni
01.2023 - Current
- Verification of claims and claim registration. Standard Operating Procedures (SoP) - ensuring all administration and data capturing requirements are met.
- Communication with brokers on a regular basis regarding the claim status.
- Resolving and or escalating claims queries.
- Attend to queries and provide regular feedback.
- Updating of claim status on policy administration system
- Requesting and reviewing of claim forms, follow ups on any outstanding documents
- Objection handling with service provider or members.
- Capture claims.
Network Assistant
Affinity Health | Benoni
01.2015 - 01.2023
- Evaluated customer information to identify issues and develop solutions, ensuring high-quality service.
- Communicated with clients to clarify account services, statements, and balances, enhancing customer understanding.
- Provided primary support to internal and external customers, resolving inquiries and improving satisfaction.
- Communicated with clients regarding account services, statements, and balances.
- Scheduled individual meetings with managers and staff to discuss performance.
- Developed and updated key performance indicators for management review.
- Requested and organized office supplies to maintain inventory levels.
Education
Matric -
Sunward Park High
Boksburg 01.2013 - 01.2013
Skills
- Claims Negotiation
- Claim processing
- Claims verification
- Data capturing
- Information verification
- Administrative Support
- Customer Service
- Client Interaction
- Objection handling
- Attention to detail
- Multitasking
- Time Management
- Problem solving
- MS Office and Compliance
- Customer communication
- Communication skills
CUST
English, Afrikaans
Language
English, Afrikaans
Timeline
Claims Administrator
Affinity Health | Benoni
01.2023 - Current
Network Assistant
Affinity Health | Benoni
01.2015 - 01.2023
Matric -
Sunward Park High
01.2013 - 01.2013