Tamzyn-Lee Martin

• Registering of claims on Integrity
• Gathering all claim documents to submit through to insurers.
• Assess quality of supporting documentation received to uphold compliance and accuracy.
• Appoint loss adjusters on claims.
• Follow up on process of claims - including logging, tracking and coordinating with insurers for swift resolutions.
• Process all claim payments required
• Submitting and dealing with attorneys for third- party approaches and recoveries for motor claims
• Arrange collection of salvage for non-motor claims
• Arrange car hire
• Save all claim supporting documentation into claim files
• Maintain diary management for follow-ups Actively address and resolve client queries and concerns promptly and effectively
• Capture motor claims onto Hollard SPM system
• Liaise with clients, Insurers, and service providers
• Training and Mentoring

Claims Registrations
• Accurate registration of new claims on Integrity
• Estimate (as accurately as possible) the claim quantum reserve on Integrity
• Confirm if insured has the cover in place
• Assess merits of claim validity in terms of policy wording
• Create claim folder within client's profile ensuring the correct date of loss, claim number and claim narrative is captured.
• Send claim intimations to Insurers Claims Administration
• Act as intermediary between insurer, broker, and client, and timeous relay communication, requests, and documentation
• Capturing Insurers claim numbers and claims handlers' details into Integrity
• Adhere to Insurers mandates and administer mandated claims process according to defined claims procedures until claims are finalised
• Appointment of assessors, loss adjusters, service providers, upliftment, and recovery agents etc
• Once reports from Assessor/Loss Adjusters/ Service providers are received, update the claim quantum on Integrity
• Drafting assessment requests, authorisation letters, Agreement of Loss, and Cash in Lieu Forms for stakeholders. (This process is done manually on MS word template, then converted to PDF and then attached into an email)
• Answer incoming calls, respond to stakeholders' emails, and assist walk-in clients
• Manage, resolve, and attend to stakeholders' queries and objections/complaints via emails and/or telephone professionally.
• Keep relevant stakeholders up to date on the progress of registered claims
• Payment liaison between the client, Insurers, brokers, and service providers
• Inform the underwriting department to remove items off policies once the claim has been finalised
• Diary management and follow up of outstanding and/or unresolved claims with clients or insurers
Always keep internal systems and records up to date:
• Electronic filing of all claim correspondence and digitised document management
• Telephonic comments captured under notes for each claim
• Update claim status and/or close when appropriate on Integrity
• Update relevant registers for Insurers: recovery, salvage, repudiation, complaints etc

Claims Payments (within mandate)
• Capturing and processing of all stakeholders' payments on Integrity and Insurers payment spreadsheet
• Inform management of cheque requisitions to be authorised on integrity (2 x authorisations required)
• Once cheque requisitions have been authorised, capture payments into Nedbank Corporate Banking platform and save batch authorisation sheet on desktop
• Send authorised cheque requisitions and batch authorisation sheet to management via email, to authorise in Nedbank Corporate Banking platform.
• Once payments have been authorised, capture batch reference number into each claim on Integrity and into Insurers payment spreadsheet
• Request a top-up for our claims bank account from Insurer (mandate: R 1 million)

Recoveries, Liabilities, and Salvage
• These services are outsourced to approved network of service providers by the Insurers
• Claim intimation to service providers with claim supporting documents when an approached is receivedor an upliftment is required
• Assist third party Insurers / service providers with information when legally appropriate
• Inform third party claimants who wish to claim directly from our client's insurer, the process and what claim supporting documents are required via telephone and/or email

Binder Agreement
A binder agreement is an agreement between an insurer and a 3rd party (binder holder) whereby the insurer mandates the binder holder to perform certain functions for and on behalf of the insurer in connection with the administration of insurance policies and claims.
• Advise insurer of claims over mandate
• Arrange approval and payment from Insurer
• Report any suspected fraud, misrepresentation and/or dishonesty
• Binder agreement with Infiniti Insurance.
• Claims mandate is currently R350 000 and the following claims must still be referred to Insurer regardless of quantum:
o Rejections
o Staff and family members of staff
o Saria claims
o Legal Matters
o Liability claims (excluding Motor Liability)
o Stolen Vehicles – Notification only unless over mandate
o Write-off Vehicles – Notification only unless over mandate

Insurer Environment
 Renasa Insurance
 Santam Real Estate
 CIA
 Old Mutual Insure (OMI)

Brokers
Servicing three (03) brokers and managing their expectations simultaneously, over and above my daily job function.

Mentoring
A senior colleague retired at the end of May 2022 and a new colleague started on the 1st of April 2022 in the domestic claims administrator role. My new colleague who is inexperienced within the insurance industry and is currently working under supervision until she meets the fit and proper requirements. I am teaching and providing help to my colleague with the knowledge and experience I have gained working with our Insurers policy wordings, IT systems and internal claim processes through my on-job performance and insurance studies.

• Import electronic data files onto CADI ensuring the quality of the Import, Enrichment, Validation and Activation processes of DXP policies.
• Daily and weekly DXP outstanding query reports on all DXP policies to be sent to the Sales Manager at Motovantage
• Loading of new vehicle dealerships onto Cadi for Motovantage
• Responsible for assisting the Scheme Accountant to achieve their objectives by providing value-adding, timely assistance on queries
• Accountability for ensuring that policy data is correct and complete at the time of monthly close-off (24th) and handover to the Scheme Accountant
• Dealer-standing reports to be generated and distributed weekly to the vehicle dealerships
• Responsible for running “Quality Control” reports (Sales file, Duplicate policy check, Dealer-standing,
• Draft and Query reports), as per agreed time-lines.
• Save all “quality control check” reports in their assigned folder as the history of the data validation process.

Motovantage DXP Policies - Valued Added Products sold at vehicle dealerships

• Service and Maintenance Plans
• Mechanical Warranties
• Scratch and Dent Coverage
• Deposit and Credit Life Protection
• Shortfall Cover
• Providing a professional policy administration service telephonically to policyholders and business partners
• Ensure the principles of TCF (Treating Customers Fairly) are embodied in all customer interactions
• Assist policy-holders and business partners with all types of queries relating to policies: confirming cover type, policy benefits, payment arrangements, sending policy documentation via email, cancellations, etc.
• Update policy information on Cadi when information changes
• Take responsibility for debit order retention.
• Use any appropriate client interaction as an opportunity to retain the policy.
• Responsible for identifying problems/issues that could result in a policy cancellation and proposing a workable solution to the policyholder if appropriate
• Responding to emails requests and/or queries sent from policyholders and business partners.
• Ensuring responses are within the agreed service level agreement and ultimately with one email resolution.
• Adhering to strict Quality Assurance measures when dealing with policyholders and business partners telephonically: identification of client with a three-question security check, keeping to the inbound script, offering the NPS survey at the end of the call and assisting the policy holder or business partner with ultimately an one-call resolution.

● Processing of surrenders and Out-right cessions claims
● General policy amendments as per clients’ request
● Endorse policies as per client or stakeholder instructions
● Deal with general policy enquiries
● Ensure that all FAIS requirements are upheld when providing intermediary services
● Sending clients their policy documents & tax certificates
● Manage internal and external client and stakeholder relationships in a professional manner

Nedbank Compliance Training completed:
1. Awareness Training for AML and CFT
2. Awareness Training for Sanctions Compliance
3. Corruption Risk Awareness
4. Suspicious and Unusual Transactions or Activities
5. Treating Customers Fairly assessment
6. Nedbank Wealth FACTA
7. ECG Occupational Health & Safety Act
8. ECG Employment Equity Awareness
9. ECG Compliance Risk
10. ECG Intro to FAIS
11. ECG Corporate Governance
12. Cyber Security Awareness
13. Understanding the National Credit Act