With over a decade of experience in customer service and support, I offer a wealth of expertise to effectively address client needs. Strong communication skills enable effective information conveyance and issue resolution, while problem-solving abilities drive innovative solutions. Keen attention to detail ensures accurate and efficient task completion.
Hi, I’m
Shelly Masemene
Insurance Claims Handler
White City Jabavu
Summary
Overview
18
years of professional experience
4
Languages
Work History
Planet42(Previously known as Inclusion SA)
Fleet Support Specialist
05.2022 - Current
Job overview
- Tracker Fitment Arrangements, Certificate Verifications and Vigil Cloud Monitoring of Fleet (Netstar)
- Natis Conversations via Dealerwise Application
- Existing Fleet Customer Maintenance in Relations to Rental Payments, Contract Cancellations, Vehicle Buyouts, Vehicle Breakdowns
- Insurance in Related to Claims, Authorizations, Repudiations and Write-Offs
Tshiamiso Trust
Claims Administrator
09.2021 - 11.2021
Job overview
- Prepare claims once receives from the Lodgment Centers
- Review claim submissions (Death, Tuberculosis, Silicosis and Other Illness)
- Extract the necessary Miner and medical documentation to send to MCP
- Ensure documents captured by the Lodgment Centers are accurate and sufficient for processing
- Advise when further documentation is needed
- Request Metrofile based on claim history
- Continuously update SharePoint on claim progress and produce daily reports
- Download Metrofile from OneDrive when available
- Follow and formulate Standard Operating procedures for repetitive tasks
- Work daily on various steps of the process as well as administrative support tasks
Renew-It Group(BIuespec Holdings)
Customer Care Consultant
07.2019 - 09.2020
Job overview
- Provide superior Customer Service to internal and external parties
- Ensure that all client, Insurance and Broker escalations are acknowledged and forwarded to the relevant department at the branch daily
- All quote related escalations, authorizations to be sent to the claims department
- View list of vehicles delivered correspond to the surveys completed per facility
- Ensure that after sales calls are made to clients 24 hours after delivery (target is 90%)
- Ensure that tickets are opened where necessary and email notification goes to the relevant CSA at the branch (reference with report on tickets opened for the day)
- List of vehicles delivered should be sent to Lightstone Consumer every Friday by no later than 12 noon
- Follow up quote calls to be made every Wednesday and report sent to CSI Manager on Fridays (Target 80%)
- Ensure proper brand/product knowledge is always maintained, manufacturer approvals in relation to each facility
- Ticketing system
- Average Turnaround time to close the ticket is 3 days (reference with TAT Report)
- Contact client to confirm their issues have been resolved
- Ensure Internal and External promotion of the CSI department and function of the help desk
- Overseeing and monitoring of CSA's resolution dashboard daily
- Ensure allocated branches resolution dashboard is monitored and effectively resolved daily
- List of Appeals to be sent to Lightstone consumer daily as they come
- Daily report of escalations received for the day to be sent to the CSI Manager
SATaxi Finance
Claims Manager
08.2017 - 08.2018
Job overview
- Registering Claims within the agreed SLA
- Analyze and Validate a claim made by policy holder within 24 hours
- Work Directly with Insurers and clients, ensuring the claims process without delays
- Obtain necessary claim related documents from clients
- Obtain Repair Quotes
- Appoint Assessors/Investigators as required
- Manage external investigators to achieve optimal results
- Ensure reports are received within specified timeframes
- Ensures estimates are accurately captured
- Send authorization to repairer- where vehicles are capable of repair
- Ensure settlement of a valid Claim
- Keep the client up to date through the claim process
- Provide advice on making a claim and processes involved
- Guide policy holders on how to proceed with the claim
- Identify reasons why full payment may not be made
- Identify problematic/suspicious claims and flag for investigation
- Identify any red flags in the incident circumstances
- Build relationships with relevant stakeholders
- Ensure the customer is treated fairly and that they receive excellent service in accordance with industry and company guidelines
- Treat clients in a professional manner
- Handle any complaints associated with a claim
- Accurate management of own claim portfolio within the required turnaround times and age analysis
- Constantly follow up on agreed turnaround of claim status
- Ensure that repaired vehicles are satisfactorily returned to clients and within reasonable time
- Ensure proactive management of all claims
SATaxi Finance
Insurance Inbound and Claim Registration Consultant
08.2017 - 08.2018
Job overview
- Ensuring that the team meets one required Service level
- Ensuring that all claims allocated by the claims administrator are registered within turnaround time
- Ensuring that Quality benchmark is achieved
- Handling incoming calls regarding customer queries
- Liaising with other stakeholders in order to ensure that the clients requests are met i.e
- (Policy Admin, Claims team, Sales Team)
- Conducting face to face interviews with clients in the event that they visit the branch
- Ensuring that all additional documents requested by the clients updated and sent to clients
Tibb Health Sciences(PTY)LTD
Packer/Receptionist & Administration Clerk
01.2007 - 01.2011
Job overview
- Screen telephone calls, enquiries and requests made by clients and the business
- Maintain office systems
- Completing of Job Cards
- Handled Switchboard Queries
- Type documents and letter as required and obtain quality approval documents
- Filing
- Stocktaking
- Update the computer database and spreadsheet using Microsoft computer packages
- Dispatch goods with Couriers
- Calibration of Scale
- Send Daily Reports
Education
Thulare Secondary School
Matriculated
University Overview
Basic BookKeeping certificate from Incomplete
University Overview
Telephone Etiquette Training from Onsite Training
University Overview
ULJK L3
Business Literacy from accredited business Qualification
University Overview
Business Communication Skills Holdings (PTY)Ltd
captivating customer
University Overview
Skills
Data compiling
Ethnicgroup
Ethnicgroup
AfricanResidentiallocation
Residentiallocation
1609A Mhlanga street, White City Jabavu, Soweto, 1804Personal Information
Personal Information
- ID Number: 8602090381083
- Gender: female
- Nationality: South African
Timeline
Fleet Support Specialist
Planet42(Previously known as Inclusion SA)
05.2022 - Current
Claims Administrator
Tshiamiso Trust
09.2021 - 11.2021
Customer Care Consultant
Renew-It Group(BIuespec Holdings)
07.2019 - 09.2020
Claims Manager
SATaxi Finance
08.2017 - 08.2018
Insurance Inbound and Claim Registration Consultant
SATaxi Finance
08.2017 - 08.2018
Packer/Receptionist & Administration Clerk
Tibb Health Sciences(PTY)LTD
01.2007 - 01.2011
Thulare Secondary School
Matriculated
04.2005
Basic BookKeeping certificate from Incomplete
04.2010
Telephone Etiquette Training from Onsite Training
04.2010
ULJK L3
Business Literacy from accredited business Qualification
Business Communication Skills Holdings (PTY)Ltd
captivating customer
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