Microsoft office
WANDA FEKE
Claim Specialist
Cape Town
Summary
Experienced Gap Claims Administrator in Cape Town, Western Cape with 4+ years of customer-focused experience. Proven in streamlining claim resolution processes, exceeding customer satisfaction expectations. Bilingual in English and IsiXhosa, holds a code 10 driver's license. Demonstrates exceptional accuracy and efficiency in assessing and processing insurance claims. Strong analytical skills for identifying and resolving discrepancies. In-depth knowledge of industry regulations combined with effective communication for seamless claims resolution. Multi-line Claims Supervisor dedicated to quality investigation, adjustment and supervision of diverse cases. Blends strategic planning and leadership strengths to establish top-performing claims departments. Trains and mentors staff, optimizing compliance with policies, procedures and applicable laws.
Overview
12
12
years of professional experience
3
3
years of post-secondary education
1
1
Certification
2
2
Languages
Work History
Gap Claims Administrator/Claim Specialist
Med Claim Assist Ltd
Cape Town
06.2022 - Current
- I handle inbound and outbound calls, addressing client inquiries and offering comprehensive support for Gap cover claims
- I am responsible for accurate data capturing and assist both individuals and brokers with pre authorization requests
- Additionally I aid brokers with claim submissions to Medical Aids and Gap covers, managing claims from start to finish
- My role requires me to liaise with brokers and insurance providers, ensuring each claim is processed correctly and efficiently
- I also manage telephonic queries, emails and web inquiries related to Medical Aid PMB
- I keep clients updated on their claims status, working to resolve issues promptly and uphold high service standards
Administration Intern
Med Claim Assist Ltd
05.2021 - 11.2022
- As an Administration Intern, I provided key support by scheduling meetings and generating various reports
- My responsibilities included managing all communication like phone calls, emails and correspondence ensuring all interactions were logged accurately
- I maintained precise records of operational aspects including inventory and financial data
Sales Consultant
Mobillion Group PTY LTD
Cape Town
01.2016 - 12.2016
- In this role, I handled outbound calls, presenting and offering policies to clients
- I verified clients' personal information ensuring accuracy and provided detailed product information, quotations and explanations of policy benefits
- Meeting both personal and team targets was a key part of my responsibilities as was addressing client concerns with clarity and professionalism
Casual All-rounder
Edgars
Mthatha
08.2013 - 11.2015
- I managed customer claims and queries with attention to detail, ensuring prompt resolutions that met customer satisfaction standards
- In this customer-facing role, I delivered exceptional service by efficiently addressing inquiries and streamlining processes as a Service Center Operator
- My proactive approach helped resolve complaints effectively, leading to enhanced customer loyalty and positive feedback
Education
Some College (No Degree) - Business Studies
08.2018 - 11.2020
Completed subjects: Information Processing N6, Office Practice N6, Computer Practice N6, Communication N6, and Public Relations N5.
High School Diploma -
01.2012 - 12.2012
Skills
Sales performance optimization
Office operations oversight
Problem-solving skills
Clear verbal communication
Customer communication
Claims auditing
Deadline oriented
Legal compliance
Settlement negotiation
Information verification
Confidentiality
Follow-up skills
Claims processing
Microsoft office
Assertiveness
Customer service
Data entry
Performance management
Organizational skills
Administrative procedures
Certification
NQF Level 3 Certificate in Management, OMNI, Cape Town, Western Cape, 05/01/21, 05/31/22, Covered modules in Basic Management, Operational Management, and Team Management., Topics included Introduction to Management, Business Environment, Organizational Structure and Design, Managing Meetings, Time Management, Customer Experience, Conflict Management, and Team Performance Management.
Profile Summary - Summary
Gap Claims Administrator with over 4 years of experience in customer-focused roles. Achievements include implementing strategies to reduce claim resolution times and exceeding customer satisfaction. Proficient in English and IsiXhosa, possessing a code 10 driver's license.
Software
Google workspace
Gap software (OWLS)
DocuSign/ Adobe
Outlook calendar
Timeline
Gap Claims Administrator/Claim Specialist - Med Claim Assist Ltd
06.2022 - Current
Administration Intern - Med Claim Assist Ltd
05.2021 - 11.2022
Lovedale Public TVET College - Some College (No Degree), Business Studies
08.2018 - 11.2020
Sales Consultant - Mobillion Group PTY LTD
01.2016 - 12.2016
Casual All-rounder - Edgars
08.2013 - 11.2015
Idutywa School of Excellence - High School Diploma,
01.2012 - 12.2012