CHRISTIAN SEPULVEDA
Melbourne,VIC
Summary
Business-minded professional with exemplary skills in customer service, time management and effective decision making. Bringing a together years of related experience combined with superior stakeholder relation and client relationship management abilities. Currently pursuing a change of career into an industry that can utilize current skillsets and experience to aid in achieving team goals.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Group Claims Assessor
AIA
12.2021 - 04.2024
- IP,TPD, MI & Death Claims Assessment - Portfolio of 50-70 Claims
- Relationship management between Fund Managers, Trustee and internal governance, quality and legal teams
- Outcome focused claims assessment
- Return to Work Assessment, Plans and Outcomes
- Independent Medical Requests
- RTW Program Referral's
- Effective written communication inclusive of Final Decision documents, Medical Report requests from treater, employers and third party stakeholders
- Extensive knowledge of the Life Insurance Code of Practice & effective management of claims in accordance to the code
- Transparent and empathetic stakeholder communication
- Effective claims strategy in accordance to individual policy
- Project involvement outside of BAU for digital platform improvement for claims
- Consultation with end users for adequate feedback
- Project OSS considerations - process improvement focus project.
- Streamlined the claims assessment process for increased efficiency through the development of standardized templates and checklists.
- Examined claims forms and other records to determine insurance coverage.
- Escalated complex claims to senior management for further review, ensuring a collaborative approach to decision-making and fair outcomes.
Retail IP Claims Case Manager
AMP/Resolution Life
08.2020 - 12.2021
- Complex End to End Income Protection, Death & TPD Claims Assessment
- Return to work focus outcomes
- Engagement with Rehabilitation services
- Stakeholder engagement (external & internal), relationship with claimant advisors/brokers.
Contract Role
TAL
04.2020 - 08.2020
- Assisting both Claims Case Manager Team & Claims Service Consultants
- Floating across 2 teams
- Claims Management, End to end assessment of claims, approval of small benefit claims
- Inbound and Outbound Claims related queries.
Self Employer/Partner
Day N Nite Pty Ltd
03.2013 - 03.2020
- Proved successful working within tight deadlines and a fast-paced environment.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Small Festival Operations
- Staffing/Workforce Planning
- Payroll
- Project Co-Ordination from Initiation, Planning to Execution
- Event budgeting
- Brand Partnership relations
- Venue prospecting
- Social Media Adverts/Ticketing
Claims Case Manager (Direct)
TAL
08.2015 - 11.2018
- Achieving team KPI's & meeting timeframes for assessments, follow up and ongoing assessments for claims
- Initial Claims Assessment using CAP plan structure
- Data Integrity within CRM (Fineos)
- Direct Life Insurance - Death, Income Protection, Permanent Disability
- Understanding underwriting
- In depth knowledge of insurance products and versions
- Phone contact with Claimant (Life, IP, PD)
- Managing Claimant Expectations
- Financial Assessments for Income Protection Claims
- Understanding of Life Insurance Code of Conduct and timeframes
- Working with other stakeholders to achieve claim decision in appropriate timeframes
- Writing all ongoing correspondence, Acceptance & Decline Letters
- Engaging internal and external medical providers, document providers and rehabilitation specialists when needed.
Claims Officer
TAL
05.2014 - 08.2015
- First Point of contact for insurance claimants for funeral insurance, income protection, life insurance, involuntary un-employment and permanent disability claims
- Initial Triage of claimants
- Initial Assessment of basic claim requirements
- Handling of inbound claims enquires for claimants, potential claimants and internal stakeholders wishing to know more re: policy documents
- Understanding of policy documents, including different brands rules and regulatory requirements
- Delivery of both positive and negative outcomes to claimants at initial point of contact
- Assisting with Decline letters for IU Claims
- Understanding of grief cycle and making speech adjustments to manage the phone call
- Fineos Project Involvement (CRM) system
- Change Champion during the migration into Fineos System
- Team SME/Training.
Insurance Sales
TAL DIRECT (InsuranceLine)
09.2012 - 05.2014
- Trained in all underwritten products (IPP2 & LIP)
- Trained in GA products (FP3 & ADP)
- Outbound calls
- Warm leads team
- KPI's for both talk time, commission and lead usage.
Director/Partner
Results Marketing Group Pty Ltd
10.2011 - 09.2012
- B2B Lead Generation & Sales Training
- Business Admin
- Day to day running of the business
- Staff management
- Rosters
- Staff Training
- Business Development - Cold Sales
- Relationship Management
- Sales KPI's
- Customer Service Quality Assurance.
Inbound Sales & Service Consultant
Wesfarmers Insurance/Coles Insurance/Kmart Insurance
04.2010 - 10.2011
- Average 60-80 Calls per day
- Sales to meet KPI's
- Convert Service calls to sales
- Team environment
- Working with CRM's.
Business Development Consultant
ActionCoach International
09.2009 - 06.2010
- Input sales strategies for marketing campaigns
- Cold calling/prospecting
- Converting Warm Leads
- Database building/Management (Goldmine)
- Face to face sales and consulting
- Client rapport building
- Identify Sales Opportunities
- Create sales scripts/Team sales training
- Appointment Setting
- Business Coaching Sales (B2B)
- Sales Training Sales (B2B & Consumer)
- Seminar sales (B2B / small business & Corporate Sales)
- Present Social Media Seminar for small business.
Skills
- Research and due diligence
- Collaboration and Teamwork
- Relationship Building
- Empathetic goal orientated Return to Work outcomes
- Decision-making capabilities
- Time Management
- Stakeholder communications
- Collaborative mindset
Statement
I aim to share with my new employer a strong skillset in stakeholder communication and management, outcome driven problem solving and critical decision making.
Whilst my experience is mainly in the Life Insurance industry I believe that the skillsets learnt with years of being mentored, vision for process improvement and being able to adapt, be agile to the shifting demands of governance, risk and ultimately constantly changing circumstances be translated into effective project and relationship based roles within a broad range of industries.
My aim is to join an employer who can not only hone in on my current skillset but also work with me in developing alternate skills that will allow me to adapt, grow and set up a long term working relationship with my team and brand.
I'm of the belief that long term partnerships, trust in the process and willingness to make small changes for process improving can ultimately lead to long term growth and meeting forever changing business needs.
Certification
Cert IV in Work Health & Safety - Chisholm Institute - Enrolled to commence 5/05/2024 (online completion 6 months)
RG146 Compliance - Completed at Kaplan Institute via TAL (Employer) 2013
Currently completing Certificate IV Life Insurance ANZIFF
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Group Claims Assessor
AIA
12.2021 - 04.2024
Retail IP Claims Case Manager
AMP/Resolution Life
08.2020 - 12.2021
Contract Role
TAL
04.2020 - 08.2020
Claims Case Manager (Direct)
TAL
08.2015 - 11.2018
Claims Officer
TAL
05.2014 - 08.2015
Self Employer/Partner
Day N Nite Pty Ltd
03.2013 - 03.2020
Insurance Sales
TAL DIRECT (InsuranceLine)
09.2012 - 05.2014
Director/Partner
Results Marketing Group Pty Ltd
10.2011 - 09.2012
Inbound Sales & Service Consultant
Wesfarmers Insurance/Coles Insurance/Kmart Insurance
04.2010 - 10.2011
Business Development Consultant
ActionCoach International
09.2009 - 06.2010
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