Mutabazi Sine A
Toronto,ON
Summary
Dedicated, hardworking, detail oriented, professional, and looking for an exciting role at an insurance company. Friendly insurance professional experienced in investigating and processing insurance claims. Hardworking and communicative individual excels at interpreting policies and negotiating payment solutions. Recognized for providing optimum service to policyholders and quickly identifying fraudulent claims.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Claim Service Representative
ClaimsPro
10.2022 - 05.2023
- Sign into phone queue and answer calls in accordance with client call scripts
- Intake, setup and triage claims via telephone
- Ensure claims are setup up accurately as per account instructions
- Ensure claims are fully assigned with target timeframe
- Review ECS Call report and ensure calls has terminated properly and forward accurate and complete call reports as required
- Triage property loss in accordance with severity scale
- Arrange for contractor and vendor assignments
- Arrange for dispatch of field adjusters and vendor partners when required
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements
- Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals
- Responded to inquiries by answering questions, providing information and directing customers to appropriate resources
- Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses
- Conducted full claim investigations and reported updates and legal actions
- Reviewed new files to determine current status of injury claim and to develop plan of action
- Conducted risk evaluations on claims settlement proposals to encourage sound decision-making regarding settlement offers
- Drafted and reviewed legal documents utilizing knowledge of relevant clauses to minimize incurred liability
- Prepared insurance claim forms or related documents and reviewed for completeness
- Processed and recorded new policies and claims
- Calculated adjustments, premiums and refunds
- Modified, updated and processed existing policies
- Reviewed outstanding requests and redirected workloads to complete projects on time
- Collected premiums and issued accurate receipts
- Followed up with customers on unresolved issues
- Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers
- Escalated files with significant indemnity exposure to supervisor for further investigation
- Negotiated with other involved parties to arrange settlements for maximum results
- Provided advice to customers regarding claims, rights and insurance processes to prevent disputes
- Collaborated with legal counsel to make organizational claims decisions aligning with governing laws
- Utilized appropriate cost containment techniques to reduce overall claim costs
- Generated, posted and attached information to claim files
- Checked documentation for accuracy and validity on updated systems
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents
- Maintained confidentiality of patient finances, records, and health statuses
- Maintained strong knowledge of basic medical terminology to better understand services and procedures
- Verified client information by analyzing existing evidence on file
- Posted payments to accounts and maintained records
- Made contact with insurance carriers to discuss policies and individual patient benefits
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt
- Assured timely verification of insurance benefits prior to patient procedures or appointments
- Communicated verification and authorization status updates with [Type] department to facilitate decision-making for patient admissions and insurance coverage
- Communicated effectively with staff members of operations, finance and clinical departments
- Coordinated with contracting department to resolve payer issues
- Notified insurance agents and accounting departments of policy cancellations and changes
- Determined appropriateness of payers to protect organization and minimize risk
Claims Analyst
PTA ZEP-RE
11.2018 - 07.2022
- Reviewed, analyzed, and adjusted claims for assigned market, with focus on French-speaking countries on African continent.
- Examined supporting documents, assessed reserves, and processed claim payments.
- Analyzed claims and premiums to evaluate loss ratio, providing valuable insights to underwriters to enhance policies and mitigate future risks.
- Utilized various systems to process and facilitate claim payments efficiently.
- Played crucial role in improving and implementing new framework for claims department during pandemic, resulting in direct impact and positive outcomes.
- Conducted account reconciliations with clients to ensure accurate financial records.
- Interacted with diverse clients and brokers across multiple markets, fostering strong relationships and delivering exceptional service.
- Provided training and assistance to new members joining claims department, contributing to their professional growth and ensuring smooth operations.
- Contributed to development of insurance field in Rwanda, playing key role in opening regional office and leaving positive mark in Rwandan industry.
Education
Bachelor's Degree - Actuarial Science
Sunway University
Kuala Lumpur07.2018
Post-Degree Certificate - Insurance Management
Humber College
Toronto, ON11.2023
Skills
- Damage Appraisal
- Claims Payments
- Claims Reconciliations
- Applied Systems
- Project Management
- Risk Management
- Data Analytics
- Excellent Communication
Certification
- Cartered Insurance Professional
- Successfully passed 7 Canadian insurance professional exams.
Timeline
Claim Service Representative
ClaimsPro
10.2022 - 05.2023
Claims Analyst
PTA ZEP-RE
11.2018 - 07.2022
Bachelor's Degree - Actuarial Science
Sunway University
Post-Degree Certificate - Insurance Management
Humber College
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