The Client Services Department is capacitating itself to deliver improved customer service to both internal and external SAMWUMED stakeholders. The department, which is the heart of SAMWUMED’s operations, customer interface and experience is made up of three units, namely: – the Call Centre, the Claims Unit as well as the Back Office.

Operations Manager, Ntombizonke Ntuli, said “the entire department is understaffed, placing existing resources under pressure”. The deployment of new resources will go a long way towards unblocking operational challenges and improving the overall customer services experience for SAMWUMED members, she added.

To operate at optimal capacity the Call Centre business unit has started the process of recruiting five (5) additional Call Centre Agents with claims experience and vast industry knowledge. Already, it has two Team Leaders, “allowing for effective management of teams, sharing of the workload and enhancement of productivity” Ntuli said.

The Claims Unit, on the other hand, has been capacitated with two additional Claims Assessors, bringing the total number of additional claims assessors to five (5). Among other responsibilities, the assessors validate the information on all medical claims from patients and doctors seeking payment from the Scheme. They also create, keep and maintain meticulous records of claims and follow up on lapsed cases.

Furthermore, a Technical Specialist position has been created in the same unit and filled by a previous back office Team Leader. The decision to fill the position with the specific candidate took into consideration, specific skills sets that have brought better understanding of clinical requirements for types of motivations received by the Scheme

The impact has been improved operational compliance and operational efficiency. For instance, by ensuring that all tariffs and rules are loaded and tested in compliance with the Council of Medical Schemes (CMS) rules and the standard Scheme policy and identifying systems related issues and resolving them speedily.