Sello Motsoko

• Managed a portfolio of life insurance claims, including initial and ongoing assessments.
• Liaised with claimants, internal departments, external stakeholders, and reinsurers to ensure accurate and complete claim information.
• Delivered high-quality service and support to all stakeholders, handling telephone and email enquiries.
• Applied medical, legal, legislative, and insurance industry knowledge to assess claims.
• Drafted comprehensive outcome letters and maintained strong business writing standards.
• Investigated material non-disclosures and fraudulent claims in collaboration with forensic teams.
• Assessed claims in accordance with service level agreements and obtained necessary authorizations.
• Prepared and submitted claims for payment, ensuring compliance with policy terms.
• Identified gaps in policy wording and recommended improvements.
• Prepared detailed reports on claims for senior management and treasury.
• Responded to Ombudsman queries and supported other departments with claims-related matters.
• Participated in strategic discussions and process improvements, including SOP drafting, process flow creation, and manual claims system development.
• Designed and approved claims forms for various products (Disability, Severe Illness, Death).
• Contributed to policy wording enhancements and claims communication strategies.
• Achieved positive audit outcomes from reinsurers and maintained a clean record with the Ombudsman.
• Recommended and implemented recorded business calls for improved compliance and accountability.
• Training of new staff members on application of all benefits in line with claim events and company policy

• Managed a comprehensive portfolio of life, funeral, disability, income protection, and retrenchment claims.
• Conducted end-to-end claims processing including initial assessment, documentation preparation, and final resolution.
• Liaised with claimants, internal departments, external service providers, and reinsurers to ensure accurate and timely claim outcomes.
• Investigated non-disclosures and potential fraud in collaboration with forensic teams.
• Ensured compliance with policy terms, service agreements, and regulatory standards.
• Drafted standard operating procedures and developed process flows to improve operational efficiency.
• Contributed to the design and enhancement of the claims management system.
• Reported on claims to Exco and Treasury, and managed claims committee meetings.
• Participated in strategic initiatives including product development and technical discussions with senior management and reinsurers.
• Delivered exceptional customer service and supported training for sales teams.
• Acted as Operations Manager when required.

Managed a personal portfolio of life cover, credit life, retrenchment, income protection, disability, and funeral claims.

• Received and dispatched claim documentation to relevant parties.
• Conducted desktop investigations and validated claims against policy terms.
• Liaised with hospitals, doctors, police officers, beneficiaries, and other stakeholders to gather supporting information.
• Assessed and captured claim details for payment processing.
• Handled queries and repudiated claims, providing clear communication to clients.
• Drafted correspondence to clients and internal departments.
• Collaborated with forensic teams to investigate non-disclosures and potential fraud.
• Ensured claims were processed in line with service agreements and turnaround times.

• Evaluate disability claims by reviewing medical reports, employment records, and policy terms.
• Assess claimants’ functional capacity and occupational impact using medical and occupational criteria.
• Liaised with claimants, employers, doctors, and internal stakeholders to gather supporting information.
• Conducted desktop investigations and referred suspicious claims for further forensic review.
• Ensured compliance with internal policies and regulatory standards throughout the claims process.
• Maintained accurate documentation for audit and legal purposes.
• Prepared detailed assessment reports and made recommendations for claim outcomes.
• Participated in ongoing training to stay current with medical terminology, disability trends, and industry regulations

• Received and assessed death claims, including natural and unnatural causes.
• Evaluated fully underwritten, tele-underwritten, non-underwritten, and funeral policies.
• Liaised with hospitals, doctors, police officers, funeral parlors, other insurers, and relevant institutions to gather supporting information.
• Assessed and processed payment of risk claims in line with policy terms.
• Handled client queries, drafted letters, and responded to telephone and email enquiries.
• Investigated previously submitted claims, non-disclosures, and fraudulent activity.
• Managed queries related to repudiated claims and coordinated with internal divisions.
• Provided support to other departments on claims-related matters.
• Liaised with forensic teams, reinsurers, and South African Home Affairs.
• Responded to Ombudsman queries and reviewed sales calls for compliance.
• Ensured all claims were assessed and finalized within agreed turnaround times.

• Managed client portfolios and responded to all queries via email, telephone, and mail.
• Delivered general client services including benefit statement requests and fund member updates.
• Performed monthly reconciliations and manually adjusted spreadsheets to balance contributions.
• Tracked monthly EFT contributions and updated member statuses (new, resigned, on leave).
• Sent fund revision packs to clients on anniversary dates.
• Processed withdrawal claims, screened documentation, and ensured compliance with legislative requirements.
• Applied for tax directives and verified bank account details.
• Handled and processed funeral and family cover claims.
• Investigated suspicious claims and referred cases to the forensic team.

• Received and assessed death and funeral claims in accordance with policy terms.
• Recommended claims for payment after thorough evaluation.
• Liaised with clients and all relevant parties to gather and verify claim information.
• Drafted letters to clients and stakeholders, and handled telephone enquiries professionally.
• Investigated previously submitted claims and cases of non-disclosure.
• Managed declined claims and provided clear communication on outcomes.
• Collaborated with internal divisions and FNB branches to resolve claims-related queries.
• Provided client services and support throughout the claims process.
• Liaised with reinsurers and South African Home Affairs for verification and documentation.
• Responded to Ombudsman queries and ensured timely resolution.
• Utilized the Hogan system to validate banking details and the AWD system for workflow and claims management.

• Conduct Telephonic Interviews: Engage with applicants over the phone to collect detailed medical, lifestyle, and occupational information required for underwriting decisions.
• Assess Risk Factors: Evaluate responses against underwriting guidelines to determine the level of risk and eligibility for cover.
• Verify Information: Confirm the accuracy of information provided in application forms and identify any inconsistencies or red flags.
• Document Findings: Accurately record all interview responses and underwriting notes in the system for audit and decision-making purposes.
• Liaise with Medical Professionals: Request and follow up on medical reports or additional documentation when required.
• Ensure Compliance: Adhere to regulatory requirements, company policies, and data protection standards during all interactions.
• Support Underwriting Decisions: Provide underwriters with comprehensive summaries and recommendations based on telephonic assessments.
• Customer Service: Maintain a professional and empathetic tone during calls, ensuring a positive customer experience.
• Training & Development: Stay updated on underwriting guidelines, medical terminology, and industry trends through ongoing training.