Manager Service
Resume:
Witstinkhout Road
Hennopspark
***7
Phone 082-***-****
adgilz@r.postjobfree.com
Sunel Opperman
Personal
Information
Marital status: Single
Nationality: South African
Age: 38
Education 1996 - 2000 Montana High School
Matriculated in 2000
English HG
Afrikaans HG
Art HG
Mathematics SG
Biology SG
Home Economics HG
Training and Courses:
YATS (Young Aspiring Team Managers) internal management program January 2009 – July 2009
Assessor Development Programme internal August 2010
Interview and Interrogation internal coarse
Course in Lean-Agile at Faculty Training Institute May 2016
NQF 4 Full Qualification in Short Term Insurance (183 credits)
RE 5 (Representative)
RE 1 (Key Individual)
Facilitator Training Programme through Enjo Consultants
National Certificate in Short Term Insurance NQF 5
Life work leadership course 2019
Current Studies:
Diploma in Business Analysis through Meta Performance
Bachelor of Commerce (short-term insurance)
Languages English and Afrikaans
Summary of work
experience
Oneplan Insurance
Head of group claims (Short Term, Health and Pet claims) March 2020 – present
Manage overall claims processing function, and ensure accurate and timely processing of claims within established legal and company compliance guidelines
Meet and exceed all service level requirements
Oversee and ensure achievement and maintenance of all claims processing standards within established guidelines
Ensure compliance with all claims related contractual, regulatory and legal requirements
Analysis of claims payments and denials to identify and address trends and opportunities
Identify and implement operational efficiencies and development of ‘best practice’ policies and procedures
Overall management of complete and sound claim settlements, legal reviews and investigations in accordance with company policies and procedures.
Analyse customer impact and respond to complex escalated customer service and claims processing issues to ensure that customer expectations are consistently met
Deal with customer complaints and appeals accordingly
Drive and manage quality and customer service standards
Prepare and monitor claims expenses and administration budget
Provide quality operational leadership
Contribute towards overall strategy and link to the setting of standards, targets and overall objectives
Ensure that all business process is followed
Apply basic statistical analysis to track performance variations and resolve operational performance variations
Produce and analyse weekly/monthly KPIs, dashboards and analytics to measure and improve performance
Prepare and present management information and reports as required including MANCO reports
Ensure performance issues are identified and resolved accurately and timeously and implement action plans to proactively manage any foreseeable issues
Analyse and evaluate business processes and recommend actions to streamline processes, improve operational efficiencies, and identify opportunities for reducing operational costs
Overall management and effective operation of other service offerings
Keep up to date with current statutory regulations and monitoring changes
Work with the Support Services Manager in the preparation of audits and ensure compliance with all audit requirements
Work with the Support Services Manager and Quality Assurance Team to ensure controls to prevent and eliminate fraud are always in place
Work with the Support Services Manager and Investigator on complex or fraudulent cases and provide specialist knowledge where appropriate
Represent the department in meetings with internal / external stakeholders
Build strong business relationships with key clients and stakeholders
Work with key stakeholders to improve performance of the department
Update job knowledge through the studying of trends and developments in claims processing
Manage team measures and incentive criteria
Proactively identify and manage personnel problems to ensure engaged workforce
Implementation of performance management standards to ensure high calibre team
Bring expertise, experience and skills and assist with continual training, coaching, mentoring, development, empowerment and performance of claims team.
Drive an empowered and engaged high performance culture focused on continuous improvement and service delivery King Price Insurance
(April 2017 – August 2019)
King Price insurance
Commercial Building Claims and procurement Manager July 2018 – August 2019
Ensure that claims are processed in a timeous, profitable, compliant and efficient manner and furthermore to ensure that high quality service is provided to clients and third parties at all times.
Deal with complex claims related complaints and irate clients.
Manage and report on the department’s key performance indicators. (KPA)
Implementation of new processes and policies.
Identify areas of concern and implement appropriate corrective measures.
Manage, support, coach, mentor and develop case manager and case agents, which will include performance management, staff engagement and motivation and talent management.
Communicate and interact effectively with staff.
Ensure compliance with procedures, policies and service level agreements.
Assist in determining goals and service levels of the various teams and ensure that such levels are maintained.
Drive process, system enhancements to improve efficiency and participate in ad-hoc projects.
Develop and maintain strong professional relationships with internal and external stakeholders, which will include internal support services, clients and
Manage the department’s costs against the approved budget.
Monitoring and managing the progress of claims
Ensuring fair and accurate settlement of claims
Building relationships with building managers and the supply chain
Ensuring the customer is treated fairly and that the customer receives excellent service in accordance with King Price standards and guidelines
Involvement in loss adjusting activities and in legal discussions relating to settlement
Manage / co-ordinate legal recovery of monies paid out
Taking responsibility for productivity, claims cost management and profit
Adhering to legal requirements, industry regulations and quality standards set by King Price
King Price Insurance
Facilitator (Product training, Sales and Client Care Systems training, Claims and Investigator training and Soft Skills Training) April 2017 – June 2018
Deliver appropriate training to employees
Maintain training records
Prepare and facilitate learning
Handle any training related administration and adhoc tasks
Remain updated with market trends
Research new and relevant training methods
Evaluate and assess learner competence level
Provide feedback to learners
Review training and compile consolidate feedback reports September 2004 – November 2016
OUTsurance/Momentum STI/FRSTIA/SIAS
OUTsurance
Quality Control Finish Line Tester
September 2015 – November 2016
Responsibilities:
Work in project development teams with the aim of testing system modifications and functionality
Compile detailed test plans and test cases using testing tools
Work with business during development to assist users during user acceptance testing
Log testing feedback using testing tools
Adhoc testing projects such as DR and systems software and hardware upgrades
Assist in training users and help desk staff
Handle Summit messages where user explanation is required SIAS
Motor Accident Investigator
December 2010 – August 2015
Validate all incidents and claims.
Ensure professional and thorough investigation of claims
Limit financial losses due to policy / claim fraud
Accept accountability for operational, financial and technical results
Meeting with clients, witnesses, SAPS officials, towing operators etc.
Finalise all reports and administration.
Liaise with service providers.
Make the decision – reject or settle, all administration and telephonic queries arising.
Handling and resolving all queries and problems from service provider and clients.
Conduct all the above to the required performance and quality standard that are in place.
FRSTIA
Product Trainer
April 2010 – November 2010
Take full accountability for all aspects of technical systems and product training at all levels including responsibility for:
Training need analysis and identification
Program design and development
Technical and product training and facilitation
Course evaluation
Training administration and records
Alignment of training material to Skills Development legislation
Relationship building with the management team
Monthly report writing
FRSTIA
Various System trainer (claims advisors, rescue advisors, legal advisors, investigations and assessors for motor and non-motor) November 2009 – March 2010
Training/facilitating the claims process, procedures and systems for personal & business lines short term insurance product. Training is provided to new and existing call/contact centre employees/learners (that will be joining OUTsurance, SIAS and Momentum)
One-on-one facilitation sessions with new and current staff members
Training/facilitating new processes, procedures and system enhancement to the various companies.
Invigilating learners whilst they are doing assessments (formative
& summative)
Assessing formative and summative assessments
Moderating formative and summative assessments
Conducting oral assessments as an additional supplementary assessment to the formative and summative assessments
Updating developing all training material and assessments with new product, system and procedure changes.
Updating and developing learner guides with regards to new system and procedure changes
Monthly report writing
Assisting with product training where necessary (assessing, facilitating, invigilating, etc.)
Attending and participating in formal meetings (dismissal) where learners were found not yet competent
Developing learning material
Compiling training plans/learning event plans
Ongoing evaluation of assessments
Communicating learner progress and results to management Momentum STI
June 2007 – October 2009
Commercial & Personal Claims Team Manager (motor and non-motor)
Ensure that we are correctly staffed between 08:00 and 17:00 daily
Communicate non-attendance to staff and follow up
Claim TTD/ Underwriting/ Quality checks – thoroughness, accuracy
Underwrite all claims within mandate every day. Underwrite all claims for new advisors
Refer all claims where an Investigator is to be appointed to the investigating manager.
Manage the service level on a daily basis
Responsible for all claims under R150, 000.00
Refer claims to manager above R150, 000.00 with relevant notes that the claim has been checked and approved by them
Refer any claim where there are non-disclosures of financial situation, previous claims, etc… to manager once they have worked
Work through every claim on the claims older than 10 days and 4 days
Constantly monitor staff workloads and delegate work where necessary
Check all calculations and figures
Handle queries and complaints as far as possible and use initiative in problem solving
Prepare agenda points for Team Manager Meetings on Tuesday mornings
Follow up on outstanding credit notes
Ensure Leave is correct, leave calendar must be correct no later than the 3rd of the following month
Tape Training and coaching to be done with advisors
Monitor personal call costs
Work through the MIS report where written off vehicles have not been deleted following a total loss
Loading of new Service Providers
Validation of banking details for Service Providers
Coach advisor on time Management
Reporting of hardware and system problems
Managing escalated messages and message allocations
Unlocking of Claims
Draw Symposium reports and analyse
PBS (Performance Based Salary) reports updated and correct
Conduct Team Meetings
Team Managers Reports
Coaching Sessions with team members
Audits
Resignation of Staff
Training new staff
Commercial Claims Advisor (motor and non-motor)
Capture/Register claims on the SUMMIT system
Handle admin and follow - ups concerning claims
Liaise with clients, service providers & assessors
Deal with queries from clients/service providers
Validate claims/invoices within turnaround times
Conduct all the above to the required performance and quality standards that are in place.
Personal Claims Advisor (motor and non-motor)
Capture/Register claims on the SUMMIT system
Handle admin and follow - ups concerning claims
Liaise with clients, service providers & assessors
Deal with queries from clients/service providers
Validate claims/invoices within turnaround times
Conduct all the above to the required performance and quality standards that are in place.
OUTsurance
September 2004 – May 2007
Commercial Claims Advisor (motor and non-motor)
Capture/Register claims on the SUMMIT system
Handle admin and follow - ups concerning claims
Liaise with clients, service providers & assessors
Deal with queries from clients/service providers
Validate claims/invoices within turnaround times
Conduct all the above to the required performance and quality standards that are in place
Personal Claims Advisor (non-motor)
Capture/Register claims on the SUMMIT system
Handle admin and follow - ups concerning claims
Liaise with clients, service providers & assessors
Deal with queries from clients/service providers
Validate claims/invoices within turnaround times
Conduct all the above to the required performance and quality standards that are in place.
Business Outbound Sales
Convert lead and quotes to sales in terms of the minimum quantity and quality targets are in place
Business Inbound Sales
Convert quotes to sales in terms of the minimum quantity and quality targets are in place also work on Client Care System dealing with client queries on all levels in a competent, efficient and professional way, in accordance with the quality standards that are in place and in accordance with the values of OUTsurance.
June 2001 – 2004
Q-Photo
Administrative and Production Manager
Administration
Coaching and training of new staff
Quality control
Salaries
Debits and Credits
Stock control
Handling complaints and queries
Sales assistant
Counter sales
Additional contributions
Gees Steering Committee
PBS (Performance Based Salary) Committee
Helping Hands Steering Committee
Part of project for new Desktop Investigation skillset
Optimizing of workflow process and procedures
Innovation to improve 2 admin departments to automate
Innovation of 5 mobile APP features
Hobbies and
Interests
Almost all sport however favourite 3: Formula 1, Cricket and Rugby
Outdoors camping and fishing
Gym
References
OUTsurance – Leslie Naidoo – 082-*******
OUTsurance / Momentum – Sugan Perumaul – 012-***-****
King Price Insurance – Charlene Appies – 076-***-****
King Price Insurance – Adele Beetge – 082-*******
Contact this candidate