Experience

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  Nedbank

  Apr 2010 - May 2015

  Negotiator: complex and large losses

  Personal Lines Non-MotorKey responsibilities - Appointment of appropriate resources - Customer Relationship Management - Serve as a Business Partner with relevant stakeholders - Cost effective claims handling - Claims escalation - Process improvement- Policy compliance

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  Old mutual insure

  Jun 2015 - Aug 2018

  Engineering, Assets and Construction Claim Processing: Efficiently handle and process insurance claims from start to finish, ensuring all necessary documentation is collected and evaluated.Customer Interaction: Communicate with clients, policyholders, and other stakeholders to gather essential information regarding the claim. Provide excellent customer service and maintain a professional demeanor at all times.Claim Assessment: Investigate and assess the validity of claims by reviewing policy terms, coverage, and applicable laws and regulations.Documentation: Prepare and maintain detailed and accurate records of claims, including all correspondence, conversations, and claim decisions.Negotiation: Negotiate settlements with claimants, policyholders, and third parties. Handle disputes and conflicts in a fair and effective manner.Compliance: Ensure compliance with company policies, industry regulations, and legal requirements. Stay up-to-date with changes in insurance laws and regulations.Reporting: Prepare and present regular reports on claims status, trends, and analysis to management and other relevant stakeholders.Team Collaboration: Collaborate effectively with colleagues, underwriters, legal teams, and external partners to resolve complex claims issues.Quality Assurance: Maintain a high level of accuracy and quality in claims processing. Continuously review and improve internal processes to enhance efficiency and customer satisfaction.Customer Education: Assist policyholders in understanding their coverage and guide them through the claims process, addressing any queries or concerns they may have. Show less Commercial Claims- Accurately assess and process insurance claims, adhering to company guidelines and industry regulations.- Maintain comprehensive and organized records of all claims, correspondence, and related documents.- Conduct thorough investigations to validate the authenticity and accuracy of claims, collaborating with relevant parties such as clients, adjusters, and external experts as needed.- Analyse insurance policies to determine coverage, limitations, and exclusions, and communicate these findings to stakeholders.- Effectively communicate with clients, brokers, and other stakeholders to provide updates on claim status, request additional information, and address inquiries promptly.- Engage in negotiation with claimants, third parties, and service providers to ensure fair and efficient resolution of claims.- Perform quality control checks on claim documentation to ensure accuracy and compliance with internal and regulatory standards.- Generate and present regular reports on claims status, trends, and outcomes to management for analysis and decision-making.- Deliver exceptional customer service throughout the claims process, demonstrating empathy and professionalism in interactions with clients during what can be challenging situations Show less

  • Specialist Claims Negotiator

    Jan 2016 - Aug 2018

  • Commercial Claims Negotiator

    Jun 2015 - Dec 2015
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  Bryte insurance company limited

  Sept 2018 - Mar 2019

  Large and complex claims specialist

  Engineering , Construction and MarineKey responsibilities - Accurately assess and process claims, adhering to company guidelines and industry regulations.- Maintain comprehensive and organized records of all claims, correspondence, and related documents.- Conduct thorough investigations to validate the authenticity and accuracy of claims, collaborating with relevant parties such as clients, adjusters, and external experts as needed.- Analyse applicable policies to determine coverage, limitations, and exclusions, and communicate these findings to stakeholders.- Effectively communicate with clients, brokers, and other stakeholders to provide updates on claim status, request additional information, and address inquiries promptly.- Engage in negotiation with claimants, third parties, and service providers to ensure fair and efficient resolution of claims.- Perform quality control checks on claim documentation to ensure accuracy and compliance with internal and regulatory standards.- Generate and present regular reports on claims status, trends, and outcomes to management for analysis and decision-making.- Deliver exceptional customer service throughout the claims process, demonstrating empathy and professionalism in interactions with clients during what can be challenging situations. Show less

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  Hollard insurance

  Apr 2019 - Sept 2021

  Team manager

  Engineering and Construction Key Responsibilities (not limited to)Training Identify product training requirements for the team and brokers and address them Accountability: ManagementFormulate and implement initiatives to enhance service levels and staff morale, work ethics, and skill levels.Achieve department and company targets through continuous monitoring.Accountability: ServiceFoster a service-oriented culture within the department.Monitor and ensure claims processes are executed within agreed timeframes to meet client and broker expectations.Accountability: BudgetIdentify , encourage and implement innovative ideas to reduce claims costs.Accountability: Claims Department EffectivenessMonitor staff adherence to claims processes and procedures through regular audits.Address shortcomings through meetings, and escalate poor performance to the Claims Manager when necessary. Show less

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  Santam insurance

  Oct 2021 - Jul 2024

  Complex claims manager

  Commercial and Personal (C&P)Key Responsibilities - Deliver the highest quality claim handling and customer service consistent with the Santam Commitment and CCU Claim Handling Expectations. • Handle claims of varying severity within defined technical authority including, coverage review, fact investigation, loss evaluation, and designing and executing on an appropriate claim resolution strategy. Set and maintain appropriate and timely indemnity and expense reserves in accordance with Claims Handling Expectations and Guidelines. • Proactive diary management to drive claims toward a timely resolution. • Develop and implement appropriate strategy for fair claim resolution, to include settlement negotiation where needed. • Select, direct and manage external experts and vendors, including working with experts to set appropriate budgets and effectively manage costs. Select and manage outside attorneys, where needed, including working with attorneys to set appropriate resolution strategy and budget and proactively managing costs. • Regularly provide actionable claims insights and input to internal stakeholders, including underwriters, sales and risk engineering, and studies review and analysis relating to claims, emerging risks, legal, regulatory and societal developments and other industry topics. • Assist Underwriting and others with contractual wording and risk assessments associated with particular policies or risks. • Keep Claim Management and Internal Stakeholders aware of loss potential and material claim developments, consistent with the Claim Handling Expectations and Standard Operating Procedures. • Provide accurate information and data for Claims' reporting. Comply with internal governance, legal and regulatory requirements. • Regular Claims and Insurance Industry training/education, including obtaining applicable insurance certifications/designations. Participate in regional and global projects as requested and required. Show less

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  Sasria soc limited

  Aug 2024 - now

  Manager: complex claims