Hope Maloka

• Implemented cost containment strategies by proactively identifying opportunities for subrogation or third-party recovery in applicable cases.
• Managed a high volume of complex claims, effectively prioritizing tasks to ensure prompt resolution for clients.
• Acted as liaison between clients, carriers, and internal departments, ensuring clear communication channels throughout the claims process.
• Reduced claim processing times by implementing efficient workflow strategies and streamlining procedures.
• Increased efficiency with the integration of technology solutions into daily work processes, automating routine tasks wherever possible.
• Enhanced customer satisfaction by providing timely and accurate information regarding claims status and resolution progress.
• Negotiated favorable settlements for clients through strategic analysis of claim merits and potential liability exposure.

• Reviewed policy documents thoroughly before initiating coverage assessments so as not only identify gaps but also accurately interpret terms conditions applicable each situation faced when handling specific incidents reported insured individuals businesses seeking assistance under their respective insurance plans offered managed our organization.
• Conducted thorough investigations for accurate liability determination, leading to fair claim resolutions.
• Managed a caseload of complex claims, ensuring timely settlements and maintaining client satisfaction.
• Mitigated potential losses by identifying fraudulent claims and coordinating with the fraud investigation unit.
• Negotiated favorable claim settlements by utilizing strong communication and persuasion skills.
• Assisted claimants throughout entire submission process, guiding them regarding proper documentation requirements needed substantiate requests while also clarifying expectations concerning how long investigations might take before final decisions made about whether approve deny payouts proposed based findings obtained during case evaluations conducted teams assigned specialists like myself.

• Collaborated with cross-functional teams to successfully deliver comprehensive solutions for clients.
• Managed client relationships through regular check-ins and updates on project progress.
• Evaluated client needs and expectations, establishing clear goals for each consulting engagement.
• Developed innovative strategies for clients, resulting in increased revenue and business growth.
• Negotiated contracts and agreements on behalf of clients, securing favorable terms and conditions.
• Streamlined internal processes to enhance team efficiency and improve overall project outcomes.
• Analyzed data sets to identify trends and opportunities for process improvements within client organizations.

• Reduced claim processing time for faster customer service and improved satisfaction rates.
• Identified and reported potential fraud or abuse related to claims to protect system's integrity.
• Identified fraudulent claims through thorough investigation and documentation of findings.
• Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
• Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
• Handled escalated customer concerns regarding claim denials or delays with empathy and professionalism.
• Managed workload and priorities to meet claims processing meet deadlines.
• Trained new employees on claims processing procedures, contributing to a well-prepared workforce.
• Negotiated settlements with policyholders, balancing their needs with the financial interests of the company.

Processing commercial claim

Registering and appointing Assessor

Investigate claim

• Effectively managed risk exposure by reviewing policy coverage details and applying appropriate limits during the settlement negotiation process.
• Conducted thorough investigations into reported incidents, gathering evidence from various sources to support accurate adjudication decisions.
• Consistently achieved departmental goals for claim closure ratios and customer satisfaction ratings through diligent case management techniques.
• Evaluated and settled complex insurance claims in strict timeframes.
• Researched claims and incident information to deliver solutions and resolve problems.
• Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.