Summary
Overview
Work History
Education
Skills
Interests
Educational Details - Secondary Qualification
Skills Attained
Contact Numbers
Health
Disability
Drivers Licence
Personal Information
Timeline
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Thobeka Cele

Thobeka Cele

Claims Processor / Preauthorisations Consultant
Queensburgh

Summary

Experienced and enthusiastic Consultant with track record of success across wide range of industries. Possesses exceptional interpersonal, problem-solving and analytical skills to provide advice and expertise to client organizations improving business performance. Experienced in all aspects of operations, strategy and finance.

Effective advisor communicates well with people of all ages and backgrounds. Excellent eye for detail enabling quick identification of areas for improvement and suggesting strategies to help businesses reach goals. Focused on introducing efficient systems and processes.

Overview

20
20
years of professional experience
3
3
Languages

Work History

Pre-Authorizations Consultant

Private Health Administrators
12.2023 - Current
  • Take inbound calls for admission into hospital, specialised scans, and other medical treatments
  • Apply clinical protocols, ensuring the admissions are in line with medical aid guidelines
  • Provide floor support for new consultants and internally for internal departments
  • Dealing with escalations and complaints
  • Flagging any training gaps to the learning and development department
  • Review of procedures and treatments for review as a Prescribed Minimum Benefit and against rules set by the Council of Medical Schemes

Virtual Assistant

View Ridge Family Law and Estate Planning
05.2022 - 10.2023
  • Set up virtual Zoom meetings, invited guests and disseminated agendas.
  • Monitored emails, organized inbox, and prioritized messages for supervisor.
  • Elevated client experience by providing timely customer support via phone calls, emails, and live chat platforms.
  • Answered and screened calls to provide information, schedule appointments and take detailed messages.
  • Ensured client deliverables were met on time by closely monitoring deadlines and coordinating task completion across teams.
  • Maintained a well-organized database system for improved information accessibility in daily operations.

Claims Assessor

Momentum Contact Centre
04.2015 - 06.2021
  • Manual poprocessing of medical aid claims
  • Maintained an organized case management system, allowing for easy tracking of claim statuses and facilitating efficient workflows.
  • Assisting management in the processing of complex claims, ensuring a collaborative approach to decision-making and fair outcomes.

Pre-Authorizations Consultant

Momentum Contact Centre
10.2011 - 03.2015
  • Take inbound calls for admission into hospital, specialised scans, and other medical treatments
  • Apply clinical protocols, ensuring the admissions are in line with medical aid guidelines
  • Provide floor support for new consultants and internally for internal departments
  • Dealing with escalations and complaints
  • Flagging any training gaps to the learning and development department
  • Review of procedures and treatments for review as a Prescribed Minimum Benefit and against rules set by the Council of Medical Schemes

Customer Service Representative and Technical Support Agent

Cell C Call Cellular Services
06.2008 - 07.2011
  • Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
  • Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
  • Collaborated with team members to develop best practices for consistent customer service delivery.
  • Provided coaching and mentoring to new hires, contributing to their successful integration into the team.
  • Maintained detailed records of customer interactions and transactions, ensuring accurate documentation and follow-up.
  • Resolved escalated customer issues, restoring confidence in company's commitment to service excellence.

Cashier

Nu Metro
11.2005 - 04.2007
  • Maintained a balanced cash drawer, ensuring accurate accounting at the end of each shift.
  • Built relationships with customers to encourage repeat business.
  • Worked flexible schedule and extra shifts to meet business needs.
  • Enhanced customer satisfaction by providing efficient and accurate cash transactions.
  • Answered questions about store policies and addressed customer concerns.
  • Provide excellent customer service

Education

Matric - Mathematics, Physical Science, Home Economics, English, Zulu, Biology

Queensburgh Girls' High School

Skills

Schedule Management

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Interests

Reading and research
Interacting with people
Listening to music (all genres)
Playing around with systems and gadgets (I like knowing my way around my Operating Systems)

Educational Details - Secondary Qualification

Queensburgh Girls' High School, Main Road, Malvern, KwaZulu-Natal, Queensburgh, Matric, Mathematics, Physical Science, Home Economics, English, Zulu, Biology

Skills Attained

  • Drawing up and monitoring the schedule of a small team, identifying training gaps, and working with the trainers to bridge those gaps.
  • Provide floor support to new and experienced staff.
  • Ensuring service level agreements are kept at all times and that the company does not suffer any losses.
  • Ensuring that workload is shared equally and there is no backlog.
  • Processing of claims to medical aid and ensuring that the scheme is protected at all times both financially and its reputation.
  • Judgment of clinical appropriateness for admission requests and case management as well as the judgment of legal implications, application of rules and guidelines.

Contact Numbers

  • +27 78 335 0095
  • +27 83 775 6580

Health

Excellent

Disability

None

Drivers Licence

C1

Personal Information

  • ID Number: 890506 0463 08 2
  • Date of Birth: 05/06/89
  • Gender: Female
  • Nationality: South African
  • Marital Status: Single

Timeline

Pre-Authorizations Consultant

Private Health Administrators
12.2023 - Current

Virtual Assistant

View Ridge Family Law and Estate Planning
05.2022 - 10.2023

Claims Assessor

Momentum Contact Centre
04.2015 - 06.2021

Pre-Authorizations Consultant

Momentum Contact Centre
10.2011 - 03.2015

Customer Service Representative and Technical Support Agent

Cell C Call Cellular Services
06.2008 - 07.2011

Cashier

Nu Metro
11.2005 - 04.2007

Matric - Mathematics, Physical Science, Home Economics, English, Zulu, Biology

Queensburgh Girls' High School
Thobeka CeleClaims Processor / Preauthorisations Consultant