Sibusiso Mngadi
Durban
Summary
610216516508 Detail-oriented Gap Claims Specialist with strengths in claims processing and client relationship management. Manages the assessment of claim validity, ensuring compliance with policy terms while achieving daily targets with precision. Communicates effectively with clients and brokers to manage expectations and enhance satisfaction.
Overview
15
15
years of professional experience
Work History
Gap Claims Specialist
Kaelo
Durban, South Africa
2023.09 - Current
- Captured claim information on system by following claims process.
- Verified and updated client personal information changes on policy record.
- Assessed validity of claims in accordance with terms and conditions of policy documents.
- Managed client claim expectations by applying TCF principles and communicating effectively with clients or brokers.
- Achieved daily minimum claim targets with accuracy and within service turnaround time while maintaining workflow tasks and queue.
- Processed high priority and escalated claims identified by management within 2 hours.
- Interacted with medical aids, hospitals, and practitioners regarding medical history and accounts for claim assessment.
Customer Service Specialist
Momentum Instore
Durban, South Africa
2022.12 - 2023.09
- Delivered personalised service by understanding individual customer needs and preferences.
- Processed customer orders, returns, and exchanges with efficiency, enhancing overall satisfaction levels.
- Addressed customer service enquires quickly and accurately.
- Developed customer service guidelines and procedures, standardising response times and quality of service across the team.
- Assisted customers with product-related questions, feedback and complaints.
- Oversaw customer account inquiries, accurately providing information to resolve service complaints and guarantee customer satisfaction.
- Conducted customer satisfaction surveys and analysed feedback to identify areas for improvement.
- Served as point of escalation for complex customer issues, capturing timely resolution to drive client retention.
- Collaborated with team members to share best practices and improve service delivery standards.
- Monitored customer surveys and feedback to develop corrective actions for service-related issues.
- Utilised CRM software to record customer interactions, track enquiries and maintain accurate customer information.
- Managed inbound customer service calls, efficiently resolving queries and complaints to uphold satisfaction levels.
- Engaged in continuous professional development to stay abreast of industry best practices and emerging customer service technologies.
Service Specialist
Discovery
Durban, South Africa
2018.12 - 2022.09
- Delivered personalised service by understanding individual customer needs and preferences.
- Addressed customer service enquires quickly and accurately.
- Developed customer service guidelines and procedures, standardising response times and quality of service across the team.
- Assisted customers with product-related questions, feedback and complaints.
- Oversaw customer account inquiries, accurately providing information to resolve service complaints and guarantee customer satisfaction.
- Conducted customer satisfaction surveys and analysed feedback to identify areas for improvement.
- Served as point of escalation for complex customer issues, capturing timely resolution to drive client retention.
- Collaborated with team members to share best practices and improve service delivery standards.
- Utilised CRM software to record customer interactions, track enquiries and maintain accurate customer information.
- Maximised customer satisfaction by resolving service issues promptly.
- Managed inbound customer service calls, efficiently resolving queries and complaints to uphold satisfaction levels.
Frauf investifagtion and verification Specialist
Mr Price Group
Durban, South Africa
2014.06 - 2018.11
- Enhanced customer satisfaction through the development and implementation of feedback mechanisms and service improvements.
- Maintained accurate documentation to meet programme requirements and contractual obligations.
- Conducted comprehensive market research to identify emerging trends, informing strategic planning and decision-making.
- Oversaw compliance with regulatory standards, mitigating risks and safeguarding organisational reputation.
- Delivered bespoke training programmes to staff, significantly improving team competency and performance metrics.
- Authored comprehensive reports and policy documents, influencing key stakeholder opinions and actions.
- Conducted rigorous risk assessments for projects, implementing robust mitigation strategies to protect assets.
- Presented findings from fraud investigations to senior management, providing actionable insights for risk mitigation.
- Presented findings of fraud investigations to senior management, providing insights and strategies to mitigate financial risks.
- Managed cross-functional teams in high-profile fraud investigations, ensuring comprehensive analysis.
- Coordinated with customer service teams to address client concerns related to fraud investigations.
- Managed a caseload of complex fraud investigations, ensuring timely and thorough examination of all evidence.
Call Centre
Mr Price Group
Durban, South Africa
2011.08 - 2014.06
- Collaborated with team members to achieve target results.
- Managed complaints with calm, clear communication and problem-solving.
- Maintained clean, safe working environments to eliminate accident risks.
- Achieved service time and quality targets.
- Engaged with customers to better understand needs and deliver excellent service.
- Identified issues, analysed information and provided solutions to problems.
- Built and maintained courteous and effective working relationships.
- Handled customer concerns and escalated major issues to supervisor.
- Resolved customer queries and problems using effective communication and providing step-by-step solutions.
- Picked up additional tasks to aid team success.
- Enhanced working relationships by participating in team-building activities.
- Actively listened to customers to fully understand requests and address concerns.
- Trained and mentored employees to maximise team performance.
- Demonstrated consistent hard work and dedication to achieve results and improve operations.
- Maximised customer engagement and satisfaction by delivering excellent customer service.
Education
Nkosibomvu Secondary School
Durban, KZN2010
Skills
- Claims processing
- Client relationship management
- Customer engagement
- Risk assessment
- Policy documentation
- CRM software
- Data analysis
- Service improvement
- Escalation management
- Effective communication
- Workflow management
- Problem solving
- Team collaboration
- Innovative thinking
- Compliance adherence
Languages
IsiZulu
First Language
English
Proficient
C2
References
- Mr Price Group
- Yoliswa Mzobe
- 0680819796
- Discovery
- Anele Sosibo
- 0712730245
- Kaelo
- Avthar Barath
- 0782603036
Timeline
Gap Claims Specialist
Kaelo
2023.09 - Current
Customer Service Specialist
Momentum Instore
2022.12 - 2023.09
Service Specialist
Discovery
2018.12 - 2022.09
Frauf investifagtion and verification Specialist
Mr Price Group
2014.06 - 2018.11
Call Centre
Mr Price Group
2011.08 - 2014.06
Nkosibomvu Secondary School