Pam Mkhize

Highly experienced Claims Specialist with expertise in reinsurance underwriting, claims validation, and regulatory compliance. Skilled in assessing high-value reinsurance and direct claims, ensuring accuracy, fraud detection, and policy alignment. Proven ability to manage data integrity, generate claims experience reports, and collaborate with senior management, underwriting medical officers, and legal teams for precise claims resolutions.

Skilled in optimizing claims workflows, leading audits, and enhancing operational efficiency. Passionate about delivering strategic insights through claims experience reporting and risk assessment analytics.

Locum ICU Registered Nurse - Legend Medical Solutions (Agency)

(2025-03)

• Provide holistic patient care, including wound management, medication administration, and chronic condition monitoring.
• Perform ICU nursing duties, including ventilator management, advanced life support, and continuous monitoring of critically ill patients.
• Conduct phlebotomy, IV therapy, and specimen collection, ensuring timely diagnostics and treatment adjustments.
• Respond to emergencies, providing first-line support in trauma and critical care scenarios.
• Support patient families, offering education on recovery protocols and long-term care plans.
• Uphold infection prevention and control standards, ensuring compliance with medical regulations and best practices.

Claims Specialist - SwissRe

(2022-08 - 2025-02)

Reason for Leaving: To pursue educational opportunities and an in-person training program to develop new competencies.

• Managed treaty and facultative claims, ensuring seamless processing by reinsurance policy frameworks.
• Conducted risk assessments on income protection, disability, retrenchment, and life claims, ensuring regulatory compliance.
• Oversaw data management, maintaining accuracy in reinsurance claims processing systems.
• Generated claims experience reports, analysing trends and providing strategic recommendations to underwriting teams.
• Liaised with clients, underwriting team, medical officers, legal team, and senior management, supporting high-level claims negotiations.
• Led fraud detection audits, implementing measures to mitigate fraudulent activity and financial risk exposure.
• Provided input on claims processing enhancements, streamlining workflow efficiency, and system functionality.

Claims Assessor - ABSA Group Life

(2020-10 - 2022-07)

Reason for Leaving: Transitioned to Swiss Re in August 2022, to expand expertise in specialized disability and occupational disease claims, gaining exposure to complex assessments and fraud investigations within a global insurance framework.

• Processed funeral, disability, and life claims, ensuring accuracy and policy adherence.
• Conducted disability risk evaluations with a focus on workplace-related health conditions.

Ill Health Claims Assessor - Motor Industry Fund Administrators

(2020-03 - 2020-10)

Reason for Leaving: Completion of contract in October 2020 and transition to a broader claims assessment role at ABSA Group Life, leveraging my expertise in disability and health-related claims

• Led disability assessments, including occupational disease assessments, ensuring regulatory compliance
• Worked with medical review panels, ensuring evidence-based decision-making.

Senior Claims Specialist - Discovery Life

(2013-03 - 2019-07)

Reason for Leaving: Took a career pause to provide care and support for a parent with a serious medical condition.

• Supervised claims assessing teams, mentoring junior assessors, and driving best practices in claims processing.
• Conducted data-driven claim exception analysis, identifying risk trends and fraud mitigation strategies.
• Collaborated with senior leadership, underwriting teams, and legal departments to resolve complex disputes.
• Developed claims analytics reports, providing insights on policy performance and regulatory compliance.
• Played a key role in claims committee discussions, advising on policy amendments and operational refinements.
• Managed end-to-end claims assessment, ensuring compliance with financial and medical underwriting standards.
• Led fraud investigations, analyzing financial and medical documents to detect inconsistencies and anomalies.
• Provided product enhancement input, refining claims processing frameworks for improved efficiencies.
• Delivered coaching sessions for administrators and pre-assessors, strengthening claims evaluation expertise.

Occupational Health Nurse - Life Occupational Health Care

(2011-02 - 2013-02)

Reason for Leaving: Transitioning to a role that integrates my clinical and analytical expertise into the claims assessment field, joining Discovery Life as a Claims Specialist in March 2013.

• Developed and implemented occupational health programs, ensuring workplace wellness and disease prevention.
• Conducted medical examinations and screenings, identifying early signs of workplace-related conditions.
• Provided primary healthcare services, focusing on chronic disease management and workplace injuries.
• Led workplace wellness campaigns, educating employees on occupational health risks and prevention strategies.

Clinic Manager Registered Nurse - South African National Blood Services

(2009-03 - 2011-01)

• Managed daily clinic operations, ensuring seamless service delivery and adherence to healthcare protocols.
• Led staffing functions, including recruitment, training, and supervising multidisciplinary teams.
• Ensured regulatory compliance, maintaining standards in occupational health and clinic administration.
• Oversaw budget management, optimizing resource allocation, and procurement of medical supplies.
• Addressed donor concerns, implementing strategies to enhance patient satisfaction and service experience.
• Analysed performance metrics, presenting operational reports and recommendations to senior management.

Night Shift Team Leader - Flora Clinic

(2007-08 - 2009-02)

Reason for leaving: Pursued an opportunity to gain hands-on experience in clinic management, transitioning into a full-time role at South African National Blood Services in Mar 2009.

• Led nursing teams, ensuring seamless patient care delivery during overnight shifts.
• Developed nursing care plans, ensuring personalized treatment protocols for post-operative recovery.
• Managed medication administration, ensuring adherence to hospital regulations and patient safety guidelines.
• Provided emergency response support, assisting in critical interventions and patient stabilization.

Occupational Health Nurse - Unilever Brothers

(2007-05 - 2007-08)

Reason for Leaving: Completion of contract in August 2007, followed by a seamless transition into hospital-based nursing to further expand my clinical expertise as a Registered Nurse

• Conducted pre-employment assessments & medical surveillance, ensuring fitness-to-work compliance through medical history reviews, audiometry, spirometry, and physical examinations.
• Delivered primary health care services, diagnosing and managing workplace-related conditions.
• Provided emergency medical care and handled workman's compensation cases, ensuring swift interventions for occupational injuries.

Senior Claims Assessor / Supervisor - Standard Bank

(2001-12 - 2007-04)

Reason for Leaving: Transitioned to an occupational health role in May 2007 at Unilever Brothers to apply my clinical expertise in workplace health and employee wellness.

• Supervised claims assessors, overseeing disability claims validations and workflow management.
• Managed cross-functional collaboration, liaising with underwriting teams, medical professionals, and compliance officers.
• Provided staff training and procedural updates, enhancing accuracy in claims processing.
• Developed audit review metrics, reporting claims trends, fraud risks, and policy efficiency improvements

Registered Nurse - Johannesburg Hospital

(1996-04 - 2001-11)

Reason for Leaving: Advanced my career by transitioning into claims assessment, leveraging my clinical expertise to support medical and insurance processes.

• Administered medications and monitored patient conditions, ensuring adherence to treatment protocols.
• Provided advanced life support, assisting physicians during critical procedures and emergency interventions.
• Educated patient families, offering counselling and guidance on recovery management.
• Collaborated with hospital teams, contributing to multi-disciplinary healthcare planning and case management.

Post-Graduate Diploma - HIV/AIDS Management - Stellenbosch University (2025)

Adult Primary Care - AquaH Training School (2025)

Peak Performance Programme - Stellenbosch University (2016)

Management Studies - MANCOSA (2006)

FAIS Wealth Management - Damelin (2004)

Occupational Health Nursing - Pretoria Technikon (2000)

Diploma - Nursing & Midwifery - Baragwanath Nursing College (1995)