Lusanda Nyangwa Email & Phone Number

Cape Town Area, South Africa

Receiving, analyzing and thorough investigation of casesSubmission of cases to SPNsSourcing and collation of information from members and service providers, to be presented to the Scheme and Ex-Gratia CommitteeRefer cases to Case Managers/ Medical advisors for clinical recommendation Communication with the Scheme’s Medical Advisor and members of the Ex-Gratia CommitteeAttendance and presentation of cases at Ex-Gratia committeeActioning with extreme accuracy the outcomes as agreed by the CommitteeRecording of cases for statistical purposes and the drafting of monthly reportsSecretariat support for the CommitteeDrafting minutes for the Committee meetings Investigation and resolution of escalated complaints received from the Scheme and BOT Drafting of appropriate responses to membersLoad filters for claims to be settledQuality assurance checks on cases and claims feedback

Century City

Cape Town

Attending to and investigating enquiries (e.g. claims)Handling correspondence, rejection letters, member letters and emails Capturing all changes or updates to the member's Hospital authorisation application either from the scanned documents or from faxes and e-mails received in the department When necessary, effectively co-ordinate and track the reversals and re-processing of medicine and hospital claims Attending to varied enquiries via Vitel pertaining to Customer service enquiries, hospital claims, medical advisor referrals, and HRM programme Appropriately communicating related aspects of the programmes to internal and external parties Ensuring effective administration related to Hospital Risk Management and PMB’s

Cape Town Area, South Africa

Course In Anti-Corruption And Commercial Crime Investigation

Higher Certificate In Forensic Examination

Criminal Law Labour Law Law of Evidence Administrative Law Internal Auditing Investigation of Crime

Certificate, Programme In Forensic And Investigative Auditing

Fraud Prevention Fraud Detection Fraud Investigation Forensic and Investigative Audit Reporting

Certificate, Clinical Coding

ICD 10 coding Basic Anatomy & Physiology Introduction to Basic CCSA Coding

Matric