Floris Nicolaas (Niekie) Liebenberg
Complex Claims Specialist
Bedfordview
Summary
Experienced claims professional with over 13 years in the industry, specializing in complex and high-value claims. Currently employed as a Complex Claims Specialist at Alpha Insure (Pty) Limited, where I handle all claims exceeding R1,000,000. With almost five years at my current company, I have honed my expertise in managing complex claims, delivering exceptional service, and ensuring swift and accurate resolutions. I am now seeking to leverage my extensive knowledge and leadership skills in a Team Leader role within the Complex and Property Claims department, where I can drive team performance, optimize processes, and contribute to the continued success of the organization.
Overview
13
13
years of professional experience
47
47
years of post-secondary education
Work History
Complex Claims Specialist
Alpha Insure (Pty) Ltd
Bedforview
07.2020 - Current
- Handles all Complex and Property claims over R1,000,000
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Maintained accurate records by diligently updating claim files and ensuring all required documentation was submitted in a timely manner.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Achieved performance targets consistently through attention to detail, effective time management, and strong decision-making abilities.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Identified fraudulent claims through diligent investigation and collaboration with law enforcement agencies when necessary.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Reduced fraudulent claims by implementing stringent verification processes, safeguarding company assets.
- Conducted regular audits of claim files, ensuring compliance with internal and external regulations and standards.
- Enhanced customer trust and satisfaction by efficiently resolving claims disputes.
- Constantly in communication with Co-Insurers and Brokers to resolve claims.
Claims Auditor
Quicksure (Pty) Ltd
Johannesburg
09.2017 - 06.2020
- Enhanced claim accuracy by meticulously reviewing and auditing claim submissions.
- Identified fraudulent activities by conducting detailed audits on suspicious claims, protecting company resources.
- Researched issues related to claims processing to identify origins and implement corrective solutions.
- Supported implementation of new software programs to enhance claim processing, increasing productivity and reducing errors.
- Improved interdepartmental workflows by proactively addressing communication gaps or process inefficiencies, fostering more productive work environment.
- Initiated cost containment by conducting thorough audits and data mining.
- Participated in ongoing professional development opportunities to stay current on industry trends, enhancing personal skill set and benefitting the organization.
- Served as a subject matter expert, offering guidance when needed to support overall team effectiveness.
Reviewed insurance claims and member eligibility to determine overpayment trends and noncompliance issues. - Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Mentored junior staff members, helping them develop their leadership potential and advance in their careers.
- Empowered team members by delegating responsibilities according to individual strengths and areas of expertise.
- Managed conflict resolution among team members, fostering positive and collaborative work environment.
Claims Technician
Quicksure (Pty) Ltd
Johannesburg
09.2011 - 08.2017
- Investigated claims for accuracy, verifying proper documentation to prevent fraud.
- Collaborated with team members to improve communication, resulting in a more productive work environment.
- Compiled detailed reports on claim trends for management review, leading to data-driven improvements in operations.
- Developed strong relationships with insurance carriers to facilitate prompt payment of claims.
- Reduced claim processing time by streamlining workflow and
implementing efficient procedures. - Maintained accurate records of all claims processed, ensuring
compliance with company policies and industry regulations. - Coordinated with outside vendors such adjusters for timely completion of necessary evaluations or assessments related to claims handling process.
- Assisted with training new employees, sharing knowledge and expertise to ensure smooth onboarding process.
- Expedited claim settlements by negotiating fair and reasonable
payments with clients and claimants.
Education
INSETA FETC NQF 4 - Short Term Insurance
License To Skill
Remote Learning 04.2001 - 10.2023
RE5 Regulatory Examination - Representatives in All Categories of FSPs
Moonstone
Sandton 04.2001 - 09.2020
High School Diploma -
Stoffberg High School
Brakpan 01.2000 - 12.2004
Skills
Claims processing
Settlement determinations
Claims investigation
Verbal communication
Excellent Computer literacy (Word, Excel, Outlook, Power point)
Policy interpretation
Negotiation leadership
Complex claims consulting
Recordkeeping organization
Teamwork and collaboration
Problem-solving
Time management
Multitasking
Decision-making
Self motivation
Proficient knowledge of all short-term insurance products supported by the insurance company
Timeline
Complex Claims Specialist
Alpha Insure (Pty) Ltd
07.2020 - Current
Claims Auditor
Quicksure (Pty) Ltd
09.2017 - 06.2020
Claims Technician
Quicksure (Pty) Ltd
09.2011 - 08.2017
INSETA FETC NQF 4 - Short Term Insurance
License To Skill
04.2001 - 10.2023
RE5 Regulatory Examination - Representatives in All Categories of FSPs
Moonstone
04.2001 - 09.2020
High School Diploma -
Stoffberg High School
01.2000 - 12.2004
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