MS-Word, Excel, PowerPoint & Outlook
Mpilo Steven Sibanda
Claims Specialist
Hagley, Kuils River,WC
Summary
Accomplished Insurance and claims Generalist with over 15-year history of success in short term and long-term insurance, claims and financial planning. Leverages analytical and communication skills and insurance and banking industry knowledge to help clients obtain financial goals and plan for future. Navigates multiple demands to provide high level of service in fast-paced, deadline-oriented environment.
Overview
21
21
years of professional experience
5
5
years of post-secondary education
5
5
Certifications
4
4
Languages
Work History
Financial Advisor
07.2021 - Current
- Associated with SFP - Insurance and Claims Opportunities
- Duties:
- Sourcing sufficient lead generating opportunities to ensure 10 client quotes per week and 30 per month minimum
- Meeting minimum requirement of 8 written policies per month
- Maintaining and update your Lead Generation Matrix on a weekly basis
- Once a quote is requested, contacting client to conduct a proper needs analysis and offer professional advice and adding value to short term portfolio
- Signing up a minimum of 5 active leads
- Completing weekly reports that reflect leads, quotes, and sales as well as the source of the leads, average premium, total premium and any other pertinent information which may be required from time to time
- Keeping up to date and fully informing on product comparisons with opposition products
- Staying abreast of at least 3 Insurers product changes and enhancements
- Being compliant in all activities in accordance with regulations and standards of all Insurance regulations and professional guidelines and ethics
- Maintaining appropriate skills and knowledge in order to provide specialist, professional advice in all relevant business areas
- Maintaining the required dress code and professional appearance
10.2020 - 06.2021
- Looking for claims opportunities
- Busy with computers program/skills online courses – Zoom, Ms Teams, Google Meet, and claims investigations course (LinkedIn)
- NQF Level 4: Unit standard Updates via Long Distance learning (Academy of Learning) then enrolled with MBSE.
01.2020 - 09.2020
- Insurance Campaigns – CompareGuru
- Streaming led calls and following up on personal lines insurance needs
- Updating contact client contact details and needs as per various campaign offerings
- Updating the leads register
- Re-directing leads to specialist insurance service providers
- Attending to Claims FNOL, registering claims and referring to accounts for settlements by service providers
- Reason for Leaving: End of fixed Contract and end of Insurance Projects due to lack of marketing financial support.
Audit
Division of FirstRand
Johannesburg
11.2019 - 12.2019
- Looking for claims opportunities
- Busy with personal development and interviews online courses (LinkedIn)
- Took some time to reflect and identify opportunities where I could add my skills set after retrenchment., Identifying and recording short term insurance claims per loss information system
- Accurately assessing merits and advising clients on liability aspects
- Managing all aspects of claims including costs and related administration for the department
- Developing and coordinating sustainable broker relationships to sustain operations
- Assisting business Units with claim information, formulating, validating, and finalizing claims
- Providing internal support to business units with the formulation of claims
- Verifying the validity and accuracy of claims settlement against group Assets, Liability, and other policy wordings
- Appointing, and liaising with attorneys, loss adjusters and investigators
- Negotiating settlements with insurers and suppliers where necessary
- Facilitating daily liaison with Marsh brokers around requirements and responding to queries that may be hindering the flow of new business
- Recommending correct claims settlements, initiating, reconciliation of claims and follow up through recoveries and salvage process
- Reviewing insurance policies and lease agreements/tenant improvement construction contracts and vendors' service contracts
- Monitoring payments and verifying Cash in transit declarations
- Reason for Leaving: Personal Development and Growth especially in Human Capital management.
Claims Leader
Western Insurance
Cape Town
07.2017 - 10.2019
- Acting as claims technical advisor by educating the brokers, clients and staff about claims processes and procedures
- Controlling claims effectively by monitoring accuracy of data from FNOL to finality on all claim types
- Building and maintaining relationships with Western’s claims suppliers and service providers
- Conducting regular sites visits in various Provinces in SA and Botswana with brokers, clients to resolve claims and gather information on understanding risks
- Maintaining service and quality on desired outputs within a specific function process through ensuring compliance to tactical policies, procedures, and standards
- Responsible for management of service levels and quality of claims
- Managing staff related matters and signing off all rejections
- Resolving all escalated claims queries and complaints and providing timeous feedback to brokers on claims related matters resolved
- Sharing insurance and claims knowledge, participating in the creation of new claims, underwriting standards, control systems and procedures to maintain service delivery
- Initiating change and continuous improvement in claims processes, SOPs on claims management and underwriting standards
- Reason for Leaving: Staff Reduction/Retrenchment.
Claims & ISU Support Unit Claims Leader
Collinson Group, UK Company
Century City, South Africa
02.2015 - 06.2017
- Ensuring effective Data Capturing Claims and Email Administration Assistance case setups and invoices Validations
- Effective Support to Agents in Recoveries and most functions and work assigned by our different departments in the UK
- Supporting the team leaders and team in reaching departmental objectives
- Liaising with stakeholders and service providers on new Set ups, invoice Payments and any related queries
- Managing day to day Escalations
- Daily management of workflow, staff and capacity in the various teams reporting directly into myself
- Interrogation of processes to ensure constant flow and lessening barriers in productivity
- Encouraging interdepartmental participation and cooperation with other stakeholders in the business i.e
- Sales & customer service, CATS, Underwriting etc
- Supporting teams in terms of resources, training and development and IT issues
- Reason for Leaving: Career Development working in a South African Environment (short term insurance claims).
Senior Claims Administrator
Frank.Net, Life Investment Company
Cape Town, South Africa
09.2011 - 10.2012
- Registering, Validating, Investigating and Processing Payments on all claims [Death, Critical illness, Retrenchment & Salary Protection, Disability, Funeral & Life] from first notification of loss from direct customers and Attorneys to finality
- Attending to insurance policy queries, claims administration, negotiating settlements
- Actively pursuing claims management within a call centre environment with clients
- Establishing Company’s liability on all types of claims lodged [Salary protection, Death, Injury and Illness and hospitalisation]
- Monitoring of call centre agents on claims/sales and up skilling
- Ensuring proper record keeping and reporting of relevant procedures
- Following up with clients, third parties and suppliers
- Effective registrations, requirements collections, assessments and recommendations of settlements and repudiations
- Attending to complaints, Ombudsman issues closely with the Compliance area
- Liaising with customer, operational areas, risk departments, systems, HR as well as external stakeholders
- Developing and maintaining a control framework to ensure adherence to policy and procedures
- Assisting seniors with compilation of financial reporting and claims provision for settlements
- Attending weekly claims Committee meetings to discuss complex claims issues and authorization of bone-fide claims
- Reasoning for Leaving:
- Contract ended 2012 with Claims Moved over to Standard Bank Area/environment.
Admin Claims Manager
Santam Insurance
Johannesburg, South Africa
10.2008 - 02.2011
- Liaising with underwriting departments on new risk findings/ambiguities as well as shortcomings in claims and policy wordings
- Managing relationships with internal stakeholders and external business partners [underwriting, brokers, administrators, and system providers] and liaising with other departments
- Improving and monitoring trend identification (underwriting and operating business information and processes)
- Assisting with complex and contentious claims and liaising with the Ombudsman
- Attending claims committee meetings and following through on decisions agreed upon with stakeholders
- Assisting claims staff with the interpretation of policy wording relating to claims handling/processing
- Authorizing claims settlements, payments and large complex claims and minimizing administrative costs within the claims department
- Ensuring excellent client service delivery, outstanding claims, reconciliation, and payments authorisations are finalised
- Evaluating claims to ensure reserving of the correct quantum
- Managing rejections disputes resolution and contested rejections
- Reason for Leaving: - -Divisional restructure and relocated back to Cape Town to be with Family.
Corporate Claims Broker
Risk Insurance
10.2004 - 09.2008
Senior Claims Technician
Zurich Financial Services
Cape Town, South Africa
02.1999 - 09.2004
- Efficiently registering, loading correct estimates on commercial and Personal Lines claims, following up with Direct Clients and Brokers on relevant documentation, settling and finalizing motor and non- motor claims
- Advising Claimants on Claims Requirements and Procedures and Protocol
- Ensuring proper record keeping and reporting of relevant procedures and SLA’s
- Handling, controlling, and processing all incoming claims i.e
- Liability and third-party approaches
- Ensuring claims procedures and controls are adhered to optimise customer service and SLA’s
- Establishing insurer’s liability in terms of policy, appointing the right assessors, forensic investigators on all claims
- Negotiating and administering commercial and personal lines claims settlements
- Liaising with suppliers, repairers, brokers, direct clients on settlements, quotations, and general queries
- Effectively curbing fraud, generating savings on claims and managing costs
- Rendering proper interdepartmental communication by checking premium and claims payments
- Drafting own correspondence to brokers and clients on requirements, claim status as well as claim rejections
- Exercising effective telephone manner with clients always and accurately settling claims on the system
- Reason for Leaving:- Looking for personal Growth and Development and gaining experience in a different environment.
Underwriter
Zurich Financial Services
Cape Town, South Africa
07.1997 - 02.1999
- Creating new business policies on instruction by brokers and clients; and forwarding updated policies to brokers and clients
- Efficient policy administration and problem resolution
- Continuously passing on new ideas, opportunities, marketing, and sales initiatives
- Advising Direct clients on proper covers based on needs and circumstances provided
- Keeping abreast of industry and competitor developments and pass relevant information to the team
- Ensuring accepted business within the parameters specified by underwriting manager
- Following-up on all written and telephonic quotes
- Processing of signed applications by ensuring that the documentation meets the legal requirements
- Maintaining manual/electronic insurance record/insurance files and folders by ensuring data-integrity
- Providing support and assistance to clients, consultants, closing brokers as required, with technical product information, guidance with processes and procedures
- Reverting on queries within 24 hours and accurately quoting on requests and following up on quotes
- Encouraging cross sell/up sell at time of renewals by effective negotiations
- Maintaining proper policy administration and effective co-ordination related functions
- Accurately assessing viable risk proportion, placing viable risk proportion, maintaining, and completing policy/client records
- Reason for Leaving: Promoted within the organization to a claims Technician role.
Education
FETC NQF Level -
Moonstone Business School of Excellence
01.2022 - Current
Financial planning - undefined
FPI, Institute of Southern Africa
01.2014 - 01.2014
COP – Certificate & ICiBS – Short Term Insurance 2 - undefined
Insurance Institute of South Africa
01.1999 - 01.2000
Senior Certificate - undefined
Zvamatobwe High School, Cambridge University
01.1987 - 01.1991
Skills
Microsoft Packages:MS-Word, Excel, PowerPoint & Outlookundefined
Accomplishments
- Resolved product issue through consumer testing.
- Documented and resolved service provider products which led to better informed and decision making..
- Achieved 30% book growth through effectively helping with claims resolutions.
Software
Zoom
Ms- Teams
Internet Navigation & Research
Internet Navigation
Google Meet, Skype
Certification
RE5 Representative Certificate
Interests
Cooking for my family and close friends
Watching wild life
Local Travelling and nature
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
FETC NQF Level -
Moonstone Business School of Excellence
01.2022 - Current
Financial Advisor
07.2021 - Current
10.2020 - 06.2021
ACFE Certificate with Marc Goodman. Great Insights into Fraud Examinations & Data
08-2020
01.2020 - 09.2020
Audit
Division of FirstRand
11.2019 - 12.2019
Claims Leader
Western Insurance
07.2017 - 10.2019
Claims & ISU Support Unit Claims Leader
Collinson Group, UK Company
02.2015 - 06.2017
RE5 Representative Certificate
12-2014
Financial planning - undefined
FPI, Institute of Southern Africa
01.2014 - 01.2014
Senior Claims Administrator
Frank.Net, Life Investment Company
09.2011 - 10.2012
Admin Claims Manager
Santam Insurance
10.2008 - 02.2011
FirstRand Bank Junior Leadership Programme
08-2007
Corporate Claims Broker
Risk Insurance
10.2004 - 09.2008
Certificate of Proficiency in Short Term Insurance
02-1999
Senior Claims Technician
Zurich Financial Services
02.1999 - 09.2004
COP – Certificate & ICiBS – Short Term Insurance 2 - undefined
Insurance Institute of South Africa
01.1999 - 01.2000
Underwriter
Zurich Financial Services
07.1997 - 02.1999
Denior Certificate - Cambridge University
11-1991
Senior Certificate - undefined
Zvamatobwe High School, Cambridge University
01.1987 - 01.1991
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