SIPHIWE RIBA
CLAIMS ASSESSOR
Johannesburg
Summary
Adept at leveraging data analysis for policy adjustments at BESTMED, I excel in claims evaluation and embody professional ethics. My approach has enhanced loss mitigation strategies and fostered client trust through empathetic engagement. Skilled in documentation review and teamwork, my contributions ensure efficient, results-driven outcomes in high-pressure environments. Responsible Senior Claims Adjuster with experience performing detailed investigations and researching issues. Skilled at interpreting laws, evaluating facts, inspecting damage, and analyzing case facts. Handles over [300] caseloads per month and provides exceptional customer service to policyholders.
Overview
15
15
years of professional experience
Work History
Claims Assessor
BESTMED
02.2018 - Current
- Leveraged data analysis tools to identify trends in claims submissions, guiding future policy adjustments and loss mitigation strategies.
- Maintained accurate records of all claims assessed, facilitating easy retrieval when needed for audits or internal reviews.
- Effectively managed high-pressure situations during peak periods of claims activity while maintaining professional demeanor and efficient performance levels.
- Escalated complex claims to senior management for further review, ensuring a collaborative approach to decision-making and fair outcomes.
- Established trust among clients by consistently demonstrating empathy and understanding throughout the entire claims assessment process.
Claims Assessor
Agility Health Care
01.2014 - 12.2017
- Maintained accurate records of all claims assessed, facilitating easy retrieval when needed for audits or internal reviews.
- Assisted in updating company policies based on changes in industry regulations or best practices, guaranteeing continued compliance throughout the organization.
- Participated in regular meetings with other departments to provide insights on emerging trends in claims activity, influencing strategic decision-making processes within the organization.
- Collaborated with medical professionals to obtain accurate information for precise assessments, resulting in fair claim outcomes.
Broker Consultant
THEBE YA BOPHELO MEDICAL SCHEME
04.2012 - 03.2013
- Generated revenue growth by identifying and pursuing new business opportunities in the financial market.
- Ensured compliance with all regulatory requirements by maintaining accurate documentation and records.
- Fostered trust and credibility with high net worth individuals as well as institutional investors.
- Participated in industry conferences and networking events to stay current on best practices.
CALL CENTER
METORPOLITAN HEALTH GROUP
09.2009 - 02.2012
- Assisted with recruitment efforts by participating in interviews, helping to select top talent to join the call center team.
- Maintained a calm demeanor even during challenging circumstances, exemplifying emotional intelligence as a Call Center Advisor.
- Enhanced customer satisfaction by efficiently scheduling call center agents to meet service level agreements.
- Recommended process improvements based on regular evaluations of call center metrics, leading to consistent increases in efficiency and customer satisfaction.
Education
High School Diploma -
MOHLAMME SENIOR SCHOOL
DENNILTON 04.2001 -
Skills
Documentation Review
Languages
English
Upper intermediate (B2)
Timeline
Claims Assessor
BESTMED
02.2018 - Current
Claims Assessor
Agility Health Care
01.2014 - 12.2017
Broker Consultant
THEBE YA BOPHELO MEDICAL SCHEME
04.2012 - 03.2013
CALL CENTER
METORPOLITAN HEALTH GROUP
09.2009 - 02.2012
High School Diploma -
MOHLAMME SENIOR SCHOOL
04.2001 -
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