Tanja Barnard
Claims Assessor / Case Manager
Sunninghill, Johannesburg
Summary
PRINCIPLE DUTIES: Contract Validation: - To ensure that a client policy is valid through the appropriate due diligence (such as listening to the policy sales/retention etc phone conversation). - To ensure that all premiums have been received on an appropriate policy. Document Assessment: - To ensure that all appropriate documents are in place relating to a client policy and ensure that the appropriate disclosures are made by the life assured. -To appropriately escalate any red flags / discrepancies to the relevant department (for example forensics) as and when identified. Finalization of Claim: -To ensure that the correct decision is made with regards to acceptance/declining payment of claim based on appropriate documents received and relevant contract in place. Knowledge of: -Human Anatomy, Life Insurance Principles, Basic Medical Industry.
Overview
31
31
years of professional experience
2
2
Certifications
Work History
Leader
- Speciality Life, Dread Disease and
- Disability Claims
- Reporting To Claims Business Manager
- Reason for Leaving Lateral move into Technical
- PRINCIPLE DUTIES:
- Overview:
- The Life Assessing Team Leader contributes to the organizational goals by assisting the claims
- Assessors to gather all necessary information as relating to all new existing Life Claims
- The TL should support Assessing staff by guiding them through processes and assist with difficult customer’s interactions
- The Life Claims Assessing TL should report to the Claims Business manager on all assessing related operations
- Duties & Responsibilities:
- To support the Claims BM with Assessing staff related matters
- To do KPI’s and coaching sessions with Claims assessors
- To supply and assist Admin TL with assessing stats
- To complete standard reports assessing matters and other ad-hoc reports as and when required by the Claims BM
- To audit Claims assessors and maintain quality and SLA within the Claims Assessing team
- To keep record and track all Ombudsman related claims and report back to the Claims BM on
- SLA’s
Business Manager
Speciality Life Insurance
- Reason for Leaving Personal Growth
Nurse/Patient Ratio
Night Duty
- N/A
- Reporting To Contact Centre Coordinator and
Medical Travel Supervisor
Speciality Travel Insurance
- Operations Manager, Reason for Leaving Personal growth
- PRINCIPLE DUTIES: - Supervising of Case Managers dealing with Travel cases
- Training of Case Managers on the job
- Preparing monthly rosters
- Dealing with complaints from Clients and Insured clients
- Listening to telephone calls and utilizing the ACD machine for purpose of quality, appraisals and training
- Monthly assessments of Case managers
- Liaising with Insurers re: cover decisions
- Ensuring that Procedures and Protocols are adhered to
- Counseling and couching of staff
- Discipline when needed according to the Labor Law Act
- Interviewing and appointment of new applicants when a position becomes available
- Daily, monthly and weekly stats recording
- Air Ambulance dispatch and monitoring
- Commercial Evacuation / Repatriation dispatch and monitoring
- Quoting for Commercial and Evacuation missions
- Repatriation / Evacuation Medical Flight assistant.
Registered Nurse
- Size of Unit / Ward 10 Bed Trauma and Emergency Unit
- Speciality Emergency medicine
- Nurse/Patient Ratio Day
- Duty
- N/A
Nurse/Patient, Night
- Duty 40-50 patients during the day
- 2-3 nurses on duty
- Reporting To Charge Nurse of unit
- Reason for Leaving Personal growth
- PRINCIPLE DUTIES:
- ASSESSMENTS/TRIAGE OF PATIENTS
- DAILY PLANNING OF STAFF
- INFORM UNIT MANAGER OF STAFF PHONING IN SICK OR AGENCY CANCELING AND
- ASSIST IN GETTING STAFF, TO COVER TRAUMA UNIT
- ORIENTATION, EDUCATION AND DIRECT SUPERVISION OF NEW, JUNIOR OR AGENCY
- STAFF MEMBERS AND STUDENTS
- ENSURING CORRECT STAFF ACUITY
- COMPLETION OF DAY AND NIGHT REPORTS
- ENSURING ALL POLICIES AND PROTOCOLS ARE MET,MAINTAINED AND NEW
- POLICIES AND PROTOCOLS IMPLEMENTED CORRECTLY
- GUIDANCE AND COUNCILING OF STAFF E.G
- DEBRIEFING POST RESUS
- ASSIST DOCTORS WITH PATIENT CARE, PROCEDURES FOR EXAMPLE COMMENCING
- OF INTRAVENEOUS LINES, ADMIN OF ORAL, INJECTABLE MEDICATION AS
- PRESCRIBED
- MANAGEMENT OF TRAUMA,CARDIAC,PAEDIATRIC PATIENTS
- INSERTING OF URINARY CATHETERS MALE AND FEMALE, NASOGASTRIC TUBES
- GASTRIC LAVAGE
- ASSISTING DOCTOR WITH INSERTING OF ENDOTRACHEAL
- TUBES,INTUBATION,INTERCOSTAL DRAINS, CVP AND ARTERIAL LINES
- SUTURING OF WOUNDS, AND DRESSING OF WOUNDS
- TAKING AND BASIC INTERPRETATION OF 12 LEAD ECG
- ORDERING OF EMERGENCY BLOOD
- ORDERING OF EMERGENCY X.RAY
- TAKING OF BLOOD SAMPLES AND BASIC INTERPRETATION OF RESULTS
- COMPLETION OF DOCUMENTATION
- EVALUATION AND REPORTING OF ABNORMALITIES TO THE DOCTOR
- ENSURING PATIENT SAFETY AND HOLISTIC PATIENT CARE
- PATIENT PROFILE IN THE UNIT:
- TRAUMA AND POLY TRAUMA PATIENTS: MOTOR VECHILE ACCIDENTS, MOTOR BICYCLE
- ACCIDENTS ,DROWNINGS ,STAB WOUNDS,GUN SHOTS, LACERATIONS, FRACTURES,
- ASSAULTS, SEXUAL ASSAULTS, SPORTS INJURIES,LIGAMENT INJURIES, HEMO AND
- PNEUMOTHORAX,SUICIDE ATTEMPTS, CARDIAC TAMPONADE ETC
- GENERAL MEDICAL PATIENTS, PAEDIATRICS AND ADULTS: PNEUMONIA, PULMONARY
- OEDEMA, DIABETIC PATIENTS, DIABETIC KETO ACIDOSIS, PULMONARY EMBOLISM,
- EPILEPCY, CONVULSIONS, OTITIS MEDIA, TONSILITIS, APPENDICITIS, GYNAE RELATED IE
- ABORTIONS, ASSIST WITH EMERGENCY DELIVERIES,DEPRESSION, OVERDOSES,PEPTIC
- ULCER DISEASE, GASTRITIS, OTITIS MEDIA AND EXTERNA ETC
- EQUIPMENT USED:
- CARDIAC MONITOR, DYNAMAP, DEFIBRILATOR,BLOODGAS MACHINE,EMERGENCY BLOOD
- WARMER, BEAR HUGGER,STRYKER BEDS, EQUIPMENT FOR INTUBATION, SPINE BOARDS,
- HEAD BLOCKS, STIFF NECK COLLARS, SPINEBOARD SCOOPS, SPIDER HARNASS, TRACH 3,MAST SUITS, KEDRICH,HB MONITOR,BLOODGLUCOSE MONITOR, OVERHEAD X Ray, X RAY
- VIEWING BOARD, OXYLOG, OXIMETER,SUCTION AND OXYGEN UNITS.
Contact Person
Zyl
Claims Business Manager
Cambridge
- Telephone Number 071 678 7954 Fax Number N/A
- May we approach the above referee
- Yes
- Contact Person
Contact Centre Coordinator
Stonebridge, Cambridge
- Paulshof
- Telephone Number 010 205 3052 Fax Number 011 319 6303
- May we approach the above referee
- Yes
Contact Person
David Cooper
Area Medical Director
Auckland
- Telephone Number +64 9 359 1722 Fax Number +64 9 359 1648
- May we approach the above referee
- Yes
- Contact Person (2) Mr
- Ricus Groenewald
Operations Manager
Grand Central
Midrand
- Telephone Number +27 11 541 5044 Fax Number +27 11 541 1076
- May we approach the above referee
- Yes
- Contact Person (1) Matron Lombaard
Chief Nursing Service Manager
Olivedale Clinic
Johannesburg
- Telephone Number +27 11 777 2000 Fax Number +27 11 462 8382
- May we approach the above referee
- Yes
Life Senior Assessor
Telesure Group Services
Johannesburg
11.2015 - Current
- Speciality Life, Dread Disease, Disability
- Claims and Funeral Claims
- Reporting To Claims Business Manager
- Reason for Leaving N/A
- PRINCIPLE DUTIES, Overview:
- The Life Senior Assessor (Technical) contributes to the organizational goals by providing guidance to the Claims Assessors (Life & Funeral) to gather all necessary information relating to all new and existing Life and Funeral Claims
- Also provide guidance to the Claims Assessors (Life & Funeral) with regards to the internal processes to ensure the correct decision was made on a Claims
- The report to the Claims Business Manager on all assessing related operations
- Duties & Responsibilities:
- To complete a Standard Report with regards to Claims Assessors (Life & Funeral) assessments in terms of was the internal processes followed to make an informed / correct decision on Claims as well as identifying training needs
- Providing ad-hoc reports as and when required by the Claims BM
- To audit Claims Assessors (Life & Funeral) and maintain quality and SLA within the Claims
- Assessing team
- Assist with additional projects as per Management discretion.
Life Claims Assessing
Telesure Group Services
Johannesburg
11.2015 - Current
Life Claims Assessor
Telesure Group Services
Johannesburg
09.2012 - 11.2015
Case Manager, Nurse/Patient Ratio Day
Cambridge Manor, Witkoppen, EMS Services
Stonebridge, Paulshof, Johannesburg
08.2010 - 08.2012
- Size of Unit / Ward N/A
- Speciality, Duty
- N/A
Chief Medical Officer
International SOS
Auckland
05.2006 - 02.2010
- Reason for Leaving Promotion
- PRINCIPLE DUTIES: -Obtain Clinical Updates of patients for Ambulance transfers by air or by ground
- Analyse cases and make recommendations regarding Level of Care and mode of Transport
- Presentation of cases to Chief Medical Officer with recommendations for discussion
- Presentation of cases to Fund Manager and Scheme Representatives -Asses and Manage Financial Risk to schemes
- Management of Inter Facility Transfers as per protocol
- Crisis intervention and problem solving relating to Inter Facility Transfers /Flights
- Recommend changes and upgrades in policy, procedure and protocols
- Report standard of service delivery of Call Takers and Dispatchers to Management
- Assist Call Takers and Dispatchers with Clinical Case Management
- Maintain and Develop Clinical Standard
- Liaison with external and internal role players ensure good customer relations
- Develop and Maintain relationships with formal and informal channels, clients, hospitals and
- Assistance Companies
Coordinating Nurse
International SOS Jhb
Grand Central, Midrand
12.1998 - 03.2006
- Speciality Travel Insurance
- Reporting To Deputy Medical Director, Reason for Leaving Personal growth
- PRINCIPLE DUTIES: Obtain medical reports verbally from treating doctors to ascertain the suitability of patient’s treatment and/or to coordinate the patient’s needs for transport
- Obtain medical reports from patient’s doctor or local specialists to aid treatment and to assess any pre-existing issues
- Monitor the medical aspects of evacuations and repatriations, including assessing the necessity of an evacuation and the means by which it should take place
- Liaise with medical departments of various commercial airlines for passenger clearance
- Complete medical information forms with accuracy and within required timeframes
- Maintain open communication lines with other medical and operational team members and other International SOS alarm centre employees to ensure cases are effectively managed
- Professionally document all patient case notes and details in the case management system
- Create and update all medical actions on cases to reflect the appropriate plan of action and ensure that it is reflected in the transmission synopsis for hand over to the next shift
- Ensure all tasks are fully up to date and completed within any given shift to reduce turnaround of all services
- Assist non-medical staff in obtaining relevant referrals for clients upon request, confidently using sources and local knowledge
- Ensure that patient’s information is stored appropriately in related systems and follows the internal procedures on privacy
- Patient information is not shared with other departments or externally
- Communication with clients and other alarm centres through emails or confirmations is professional and meets business standards
- Use communal email mailboxes and templates for written correspondence.
C/o
Olivedale Clinic, Fouche
04.1993 - 11.1993
Education
Matric Certificate - undefined
Pretoria North High School
Diploma - undefined
Ann Latsky Nursing College Jhb
Customer Service Management Certificate - undefined
FSB Regulatory Examination Certificate FPI Examination Body Jhb - undefined
UNISA
UCT Life Insurance Claims Assessors Short Course - undefined
Leadership & Management Certificate - undefined
Shaw Academy Jhb
National Certificate – Wealth Management (NQF5 - undefined
CKP Development Agency Jhb
Veterinary Support - undefined
Assistant Diploma - undefined
Online Academies Jhb
Certificate - Class of Business
Faisit Inspiredevelopment
Johannesburg 11.2022 - 11.2022
Certificate - Life And Disability Claims: Legal And Practical Challenges
UCT
Cape Town 07.2022 - 10.2022
Skills
Customer focusedundefined
Accomplishments
- Microsoft Excel 2000 level 1, 2003
- Call Centre Effectiveness Course 1 & 2 1999
- Time Management 2001
- Heart Saver AED CPR course 2002
- Key Skills for Effective Managers 2002
- Stress Management 2003
- Coaching Skills Workshop 2003
- Effective Leadership in a Contact Center - Course 3, 2005
- Hannover Re Life insurance & Underwriting Essentials 2016
- Udemy ISO 3100 Enterprise Risk Management for the Professional 2021.
Certification
Name of Institution (2)
Affiliations
Name of Institution (1)
New Zealand Nursing Council
Timeline
Certificate - Class of Business
Faisit Inspiredevelopment
11.2022 - 11.2022
Certificate - Life And Disability Claims: Legal And Practical Challenges
UCT
07.2022 - 10.2022
Life Senior Assessor
Telesure Group Services
11.2015 - Current
Life Claims Assessing
Telesure Group Services
11.2015 - Current
Life Claims Assessor
Telesure Group Services
09.2012 - 11.2015
Case Manager, Nurse/Patient Ratio Day
Cambridge Manor, Witkoppen, EMS Services
08.2010 - 08.2012
Chief Medical Officer
International SOS
05.2006 - 02.2010
Coordinating Nurse
International SOS Jhb
12.1998 - 03.2006
C/o
Olivedale Clinic, Fouche
04.1993 - 11.1993
Leader
Business Manager
Speciality Life Insurance
Nurse/Patient Ratio
Night Duty
Medical Travel Supervisor
Speciality Travel Insurance
Registered Nurse
Nurse/Patient, Night
Contact Person
Zyl
Claims Business Manager
Contact Centre Coordinator
Contact Person
David Cooper
Area Medical Director
Operations Manager
Grand Central
Chief Nursing Service Manager
Olivedale Clinic
Matric Certificate - undefined
Pretoria North High School
Diploma - undefined
Ann Latsky Nursing College Jhb
Customer Service Management Certificate - undefined
FSB Regulatory Examination Certificate FPI Examination Body Jhb - undefined
UNISA
UCT Life Insurance Claims Assessors Short Course - undefined
Leadership & Management Certificate - undefined
Shaw Academy Jhb
National Certificate – Wealth Management (NQF5 - undefined
CKP Development Agency Jhb
Veterinary Support - undefined
Assistant Diploma - undefined
Online Academies Jhb
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