Summary
Overview
Work History
Education
Skills
Personal Information
Accomplishments
Affiliations
References
Timeline
Generic

Zadia Shaik

Operational Team Leader
Cape Town

Summary

Dynamic professional with extensive experience in managed care environments, excelling in leadership and process improvement roles. Proven track record in managing and coaching Pre-Authorization and Quality teams, driving enhancements in operational processes to boost productivity and elevate customer experience. Actively participated in IT enhancements for operating systems, ensuring seamless integration that supports team efficiency. Skilled in implementing clinical protocols and guidelines while collaborating with auditing teams to review clinical rules, ensuring compliance and consistently meeting quality standards.

Overview

2026
2026
years of professional experience
12
12
years of post-secondary education
2
2
Languages

Work History

Eap Operational Team Leader

Momentum
01.2022 - Current
  • 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.
  • Mentored junior staff members, helping them develop their leadership potential and advance in their careers.
  • Managed conflict resolution among team members, fostering a positive and collaborative work environment.
  • Evaluated team member performance against established objectives during regular reviews, offering praise for achievements or identifying areas requiring further development.
  • Established open and professional relationships with team members to achieve quick resolutions for various issues.

Eap Resource Analyst

01.2021 - 01.2022

Pre-Auth Nurse

National Medical Plan
  • Liaison with hospital education of confirmation clerks re funds administered.
  • Liaison with providers once auths were commenced re no and what that signifies.
  • Stats collection
  • Report writing
  • Inter departmental on-going education.
  • Education of members re benefit utilization/counseling of members/family
  • Auditing of hospital accounts
  • ICD/CPT coding
  • Improving internal communication with regular inter-departmental meeting re problem areas
  • Implementation of protocols / guidelines

Director

Tammy Taylor Nails
01.2019 - 01.2025
  • Improved project efficiency with strategic planning, resource allocation, and time management practices.
  • Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
  • Boosted client satisfaction rates through exceptional relationship management and prompt resolution of issues.
  • Negotiated favorable contracts with vendors for reduced costs and improved service quality.

HRM Team Leader

  • Manage case management, admin and clinical auditors.
  • Allocate daily duties.
  • Maintenance of the SLA /TAT
  • Provide guidance and support to the team.
  • Building rapport with the internal and external clients
  • Work on trends and gaps identified to improve the processes of the team.
  • IT development to enhance/ reduce the work in case management.
  • Review of CARM rules in conjunction with auditors to ensure that the work brought in is pertinent.
  • Responsible for scheme reporting
  • Escalation management
  • Liaison with the provider team

Quality Team Leader

  • Manage the admin, non-disclosure and clinical coaches in Pre-Authorisation dept.
  • Allocate daily duties.
  • Performing QA in the Pre-Authorisation environment
  • Perform call audits and buddy with staff.
  • Work on trends and gaps identified to improve.
  • Liaison with clinical coaches and trainer to address gaps.
  • Provide feedback to team leaders and manager on team performance and areas of growth.
  • Involved in introduction of prompts / pop up to assist staff.
  • Loss process investigation and preparation for review by senior management
  • Deal with escalations related to non-disclosure from member / brokers.
  • Responsible for scheme reporting related to non-disclosure.

Pre Auth –Team Leader

  • Manage the staff.
  • Allocate daily duties.
  • Maintenance of Service levels
  • Provide clinical support to the Pre-authorisation department.
  • Liaise with other departments with regards to queries
  • Participate in IT projects for system development.
  • Assist with testing during IT development.
  • Writing of clinical rules for IT upgrade
  • Liaise with providers/members regarding Pre-authorisation queries.

Clinical Interventionist

  • Intervening on high costing admissions at Pre-Authorisation level
  • Managing multiple admissions
  • Provide clinical support to the Pre-authorisation department.
  • Assist with case management.
  • Reporting to funds on high costing cases

Case Management

Sovereign Health Onsite
  • Provider liaison with members re funds; limits; benefits with a view to determining the best outcome at all times.
  • Updating clinical info as to appropriateness
  • Visiting of family/to update patient and educate members timeously/pro function.
  • Liaison with view to early discharge/stepdown/home-nursing
  • Negotiating discounts
  • Timelous interaction before accounts is released.
  • Level of care intervention done
  • Reports/stats collation re savings under various funds
  • Team leader/chaired meetings for case managers
  • Prep of cases for ex-gratia/fund management
  • PMB case management re-coding; updating; liaising with fund management.
  • Provider liaison/member liaison with a view to always determine best outcome.
  • Updating length of stay re refunds; limits; benefits.
  • Admin re-leave requests, keeping of register.

Telephonic

  • Updating clinical information/funds managing
  • PMB-liaising with doctors to move to DSPs for various funds
  • Liaising with DSP – governmental departments; then creating an auth and managing this care for clinical appropriateness
  • Liaison with stepdown facilities
  • Authorising of benefits: high claims/abusers
  • Referring high claimers/abusers to counselling department

Provider liaison nurse

National Medical Plan
01.1996 - 01.2004
  • Assisting doctors and hospitals with account queries
  • Liaison with providers and hospitals
  • Education of providers about funds administered.
  • Drawing up of guidelines/protocols with consultants
  • Education of staff within the organisation re-functionality of the clinical department
  • Updating clinical information and rand number of accounts with hospitals
  • Stats collation for critical pathways
  • Drawing up of reports and doing pilot studies
  • Brainstorming to develop clinical department / IT system.
  • Sitting in with multi-disciplinary team for MAC meetings to give clinical input.
  • Preparation of cases for MAC / Ex gratia
  • Research of cases for MAC / Ex gratia

Registered Nurse

St Aiden’s Mission Hospital
01.1995 - 01.1996
  • Surgical ward day and night duty in charge of ward
  • Orthopedics day and night

Registered Nurse

St Aiden’s Mission Hospital
01.1994 - 01.1994
  • Surgical ward day and night duty in charge of ward
  • Medical ward day and night duty

Staff Nurse

St Aiden’s Mission Hospital
01.1990 - 01.1991
  • High care; day duty/night duty in charge of unit
  • Paediatrics day and night duty
  • Surgical ward day and night duty in charge of ward
  • Medical ward day and night duty
  • Casualty day duty King Edward
  • Scrub nurse/Recovery-Minor cases King Edward
  • Orthopedics day and night High care
  • Day duty/night duty in charge of unit
  • Paediatrics day and night duty
  • Surgical ward day and night duty in charge of ward
  • Medical ward day and night
  • Casualty day duty King Edward
  • Scrub nurse/Recovery-Minor cases King Edward
  • Orthopedics day and night
  • Maternity day and night duty.

Education

Enrolled Nurse -

St Aidens Mission Hospital
Durban, South Africa
01.1988 - 12.1990

Bridging Student - undefined

St Aidens Mission Hospital
01.1992 - 12.1994

Midwifery -

St Aidens Mission Hospital
Durban, South Africa
01.1994 - 12.1995

Occupational Therapy -

M L Sultan Technikon/ Durban University of Technology
Durban, South Africa
01.1996 - 12.1996

Nosa Course & Audiometry -

M L Sultan Technikon/Durban University of Technology
Durban, South Africa
01.1996 - 12.1996

Telephone Etiquette -

Bell Equipment / NMP
Durban, South Africa
01.1997 - 12.1997

Customer Service -

Bell Equipment
Durban, South Africa
01.1997 - 12.1997

Case Managers Training -

University of Pretoria
Pretoria, South Africa
01.1998 - 12.1998

Advanced Microsoft Word -

Sovereign Health
Durban, South Africa

Skills

Patient education

Direct patient care

Case management

Operational excellence

Training and mentoring

Staff development

Cross-functional coordination

Management

Project management

Personal Information

Contact Number: +27 84 890 2623

SA ID Number: 7006050191089

Date of Birth: 5 June 1970

Valid Drivers License

Cape Town, 7095

Accomplishments

  • Diploma enrolled nurse Distinction with honors
  • Diploma in general nursing
  • Diploma in midwifery
  • Occupational Health cum laude

Affiliations

SANC (South African Nursing Council)

References

Momentum Health Solutions: Clint Murugan - 0823381289

MMI: Gina Hibbins - 0826062532 

MMI: Gisella Fourie - 0848931783

Momentum Medical Scheme Administrators: Desiree R Govender - 0823765526

Timeline

Eap Operational Team Leader

Momentum
01.2022 - Current

Eap Resource Analyst

01.2021 - 01.2022

Director

Tammy Taylor Nails
01.2019 - 01.2025

Case Managers Training -

University of Pretoria
01.1998 - 12.1998

Telephone Etiquette -

Bell Equipment / NMP
01.1997 - 12.1997

Customer Service -

Bell Equipment
01.1997 - 12.1997

Provider liaison nurse

National Medical Plan
01.1996 - 01.2004

Occupational Therapy -

M L Sultan Technikon/ Durban University of Technology
01.1996 - 12.1996

Nosa Course & Audiometry -

M L Sultan Technikon/Durban University of Technology
01.1996 - 12.1996

Registered Nurse

St Aiden’s Mission Hospital
01.1995 - 01.1996

Registered Nurse

St Aiden’s Mission Hospital
01.1994 - 01.1994

Midwifery -

St Aidens Mission Hospital
01.1994 - 12.1995

Bridging Student - undefined

St Aidens Mission Hospital
01.1992 - 12.1994

Staff Nurse

St Aiden’s Mission Hospital
01.1990 - 01.1991

Enrolled Nurse -

St Aidens Mission Hospital
01.1988 - 12.1990

HRM Team Leader

Quality Team Leader

Pre Auth –Team Leader

Clinical Interventionist

Case Management

Sovereign Health Onsite

Telephonic

Pre-Auth Nurse

National Medical Plan

Advanced Microsoft Word -

Sovereign Health

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