Shihlamariso Shiburi
Claims Assessor
Kempton Park
Summary
I am a highly motivated and results-driven professional with over 8 years of customer service experience, including 5 years in administration and insurance claims. I am passionate about securing a challenging career opportunity that will allow me to further develop my skills, knowledge, and professional growth. With strong communication, problem-solving, and administrative abilities, I am committed to making a valuable contribution to an organization and supporting its goals through dedication, efficiency, and excellent service delivery.
Overview
3
3
Languages
7
7
Certifications
10
10
years of professional experience
Work History
Claims Assessor
Clientele Life (Ltd)
10.2024 - Current
- Assessing death claims for Funeral Plan Products
- Working with clients and other departments to gather all relevant documents for the claims process.
- Working with systems like XDS, Claims portal, InTouch, Unity Portal
- Communicating with external sources like Investigation Officers, hospitals, Doctors, Funeral Parlors to gather confirmation of death in case of suspicions of fraud.
- Working with High Risk for further investigations on fraudulent claims.
- Ensuring that clients are contacted for payments confirmations and also repudiations.
- Ensuring that pending claims are attended to by always contacting the claimants to send required documents so that the claim can proceed.
- Providing customer service through telephone and responding to internal queries that are sent through.
- Ensuring that a monthly target, is reached.
- Ensuring that clients are treated fairly
Claims Consultant
Pioneer Wellness (Pty)Ltd
01.2021 - 09.2024
- Working with Credit Life and funeral Plan Products.
- Initiating claims and liaising with product administrator and insurer regarding processing of claims.
- Working with clients to gather all relevant documents for the claims process.
- Providing telephonic and face-to-face claims outcome to clients.
- Guiding clients with repudiated claims, on the companies’ complaints process.
- Maintaining records on all claims received and the outcomes for compliance and recorded purposes.
- Keeping records of claims payments and reconciling these with the administrator and insurer throughout the claim period.
- Retaining clients intending to cancel their existing policies, for both Funeral Plan and Credit Life.
- Providing financial services via telephone and face-to-face.
- Working on monthly default reports and ensuring collection on clients which defaulted.
- Providing customer service through telephone and face-face, answering customer enquiries, and working as a switch board for the company.
- Working closely with the Key Individual and Groups Risk Officer to record and mitigate risks detected in the company.
Administrative Assistant
Pioneer Wellness (Pty)Ltd
08.2019 - 12.2020
- Responsible for all Admin related queries, respond to such queries using either email, calls and face-to-face for walk-in clients.
- Resolving queries which fall under scope of work (Pioneer Wellness Queries).
- Liaise with all stakeholders (PDS Departments etc.), regarding queries received from clients which form part of their respective duties.
- Processing any refund in the department, which is not linked to processing of Claims and Reviews.
- Sending policy documents to clients, if needed.
- Review clients’ policies.
- Calling clients for policy reviews.
- Sending policy documents to clients using either Email, SMS Link (TABS) and Posting system.
- Liaise with different departments regarding queries which emanate from the review conversation with the client.
- Updating Simplicity and Share Point, Review spreadsheet upon completion of the review.
- Refunding clients if any refund is due.
Client Services Agent
CCI Call Center -MTN
04.2016 - 12.2018
- Providing customer services on the phone, to clients experiencing issues with their phones or network.
- Escalating queries to other relevant departments.
- Cross-selling of other MTN products to calling in clients.
- While working at Pioneer Wellness, I had the opportunity to spend a month in the accounts department. During this time, i gained valuable exposure to various Financial Systems like Sage and Fund Managements processes, which broadened my understanding of Organizational Finance and accounting operations.
Education
Matric -
Hudson Ntsanwisi Secondary School
Limpopo12-2011
Diploma - Finance Management
Regent Business School
Durban, South Africa09-2014
Bachelor of commerce - Finance Management
Oval International Computer Education
Durban, South Africa05-2016
Post Graduate Diploma in Management
Regent Business School
Gauteng 04.2001 -
Skills
Microsoft Office (incl outlook)
Simplicity
Sage Pastel
Problem Solving
Excellent interpersonal skills
Team player
High-Impact Communication
Certification
RE5; Representative 2024
Timeline
Claims Assessor
Clientele Life (Ltd)
10.2024 - Current
Claims Consultant
Pioneer Wellness (Pty)Ltd
01.2021 - 09.2024
Administrative Assistant
Pioneer Wellness (Pty)Ltd
08.2019 - 12.2020
Client Services Agent
CCI Call Center -MTN
04.2016 - 12.2018
Post Graduate Diploma in Management
Regent Business School
04.2001 -
Matric -
Hudson Ntsanwisi Secondary School
Diploma - Finance Management
Regent Business School
Bachelor of commerce - Finance Management
Oval International Computer Education