Claims Manager- Pioneer Life
Pioneer Assurance Company Limited; April 2021 to Date
Duties and Responsibilities
- Overseeing the claims department to ensure that the company is completing appropriate investigations within the letter of the law
- Provide expert input regarding day to day procedures and work with management to adjust them as needed
- Ensuring legal compliance of the claims process
- Building and motivating the team to hit productivity goals
- Adjusting protocols based on company needs
- Attending educational sessions in the event of new laws or changing business directives
- Settling difficult or complex claims
- Handling customer disputes
Assistant Manager- Group Life Claims Department
Pioneer Assurance Company Limited; April 2017 to April 2021
Duties and Responsibilities
- Determine and approve claims up to the authorized claims limit.
- Accurate and efficient claims settlement in accordance with policy provisions within the service turnaround time.
- Assist in answering enquiries from clients, intermediaries, clinics and hospitals regarding claims adjudication, payment, co-payment, reasons for rejection, missing/additional information, etc.
- Correspond with intermediaries or claimants or interview them in person to correct errors or omissions on claim forms to investigate questionable entries.
- Assist in feedback management and service recovery.
- Ensure all complaints and appeals from members and corporate clients are dealt with promptly, efficiently and professionally.
- Prepare any statistical reports and information required by management.
- Monitor and review the quality and accuracy of work performed by junior team members, take corrective action and report problems as necessary.
- Take on any other duties and responsibilities given from time to time
Underwriting and Claims Officer Group Life and Pension Department
Pioneer Assurance Company Limited; July 2014 – April 2017
Duties and Responsibilities
- Analyze customers’ data
- Assess applicant’s risk
- Determine coverage and premium
- Preparing policy documents
- Providing advice on making a claim and processes involved.
- Processing new claims
- Collecting accurate information and documents to proceed with a claim
- Investigating potentially fraudulent claims
- Building relationships with different clients
- Handling any complaints associated with both underwriting and claims
- Ensuring the client is treated fairly and the customer receives excellent services in accordance with the company guidelines.
Actuarial officer
Pioneer Assurance Company Limited; July 2013 to July 2014
Duties and Responsibilities
- Analyze statistical information to estimate mortality, accident and retirement rates.
- Ascertain premium rates required and cash reserves and liabilities necessary to ensure payment of future benefits.
- Collaborate with underwriters, accounts, claim experts and senior management to help companies develop plans for new lines of business or improving existing business.
- Provide expertise to help financial institutions manage risks and maximize returns associated with investment products.
- Design, review and help administer insurance, annuity and pension plans, determining financial soundness and calculating premiums.
Customer Service Representative
Pioneer Assurance Company Limited; January 2011 to June 2013
Duties and Responsibilities
- Responding to clients’ correspondences
- Processing of claims
- Replying to emails from clients and branches.
- Answering client queries through the telephone
- Attending to clients face to face and providing them with product and service info.
OTHER PAST EXPERIENCES
Intern- Pioneer Assurance Company Limited; August-December 2010; I was on internship for the period above in customer service department as a customer service attendant. I was tasked with Processing of refund claims, detecting bad businesses and advising management on the same and ensuring client retention.
Intern- Ministry of Trade; May-August 2009; I was on attachment for the period above in the procurement department (at the stores) in the ministry of trade.
Office Assistant- Invesco Insurance Company; May-August 2008; I was tasked with Entering raw data of the policy holders, typing of the certificates required to show the policy taken and handling policy work.
