Delyse Titie

• Managed daily operations of the claims department with a focus on re-establishing resource capacity and culture.
• Responsible for directing all claims activities and end to end functions with in service level agreements and code.
• Proactively managed complex, contentious, fraudulent and high cost claims, maximising cost containment and reinsurance opportunities to limit leakage and improve overall cost controls.
• Monitored processes and systems with initiatives to enable operations to effectuate and provide optimum levels of quality service efficiently.
• Set, enforced, and optimized internal processes and procedures to maintain responsiveness to demands.
• Reduced operational risks while analyzing data to forecast performance trends, implementing strategies to mitigate risks.
• Managed individual, team and operational performance leading to increased accountability, engagement and improved performance outcomes.
• Monthly operations reporting to internal, external, regional and global stakeholders.

Achievement Highlight:

• 2023 - Mozo Peoples Choice Award - Excellent Claims Experience and Excellent Customer Service
• 2023 - Allianz Jetsetter Award - Australian Travel Operations and Medical Assistance: Team of the year

• Change lead and Subject Matter Expert across multiple successful transformation projects within Travel and International Health Insurance businesses
• Actively involved in systems development life cycle and end user testing, artificial intelligence modelling, system performance monitoring and ongoing continuous improvement
• Developed, scheduled, and delivered change activities, communication, and end user training
• Developed and implemented standard operating procedures, policies and processes reinforcing best practices and governance, data protection, compliance, and regulatory obligations

Achievement Highlights:

• Projects: Australian Financial Services Licence, General Insurance Code of Practice 2020, Payment Card Industry Data Security Standard (PCI DSS)
• Analyzed all aspects of Travel Insurance business to ensure regulatory compliance. Established standard operating procedure, processes, and policies to strengthen product sales, claims and complaints management processes.
• Projects: Multiple system and application upgrades
• Upgraded multiple legacy systems and applications and re-designed usability to streamline workflow including email and call enquiries, and efficient distribution of claims by value and complexity. Introduced short message service (SMS) to call flow interactive voice response (IVR) to divert simple customer enquiries to online form. These resulted in better user experience with quicker overall response times and improved data maintenance
• Program: Online Claims Portal and Automation Program
• Significantly transformed customers' claims experience by introducing compliant online portal with internal artificial intelligence model. This resulted in reduction to processing time and improved outcome accuracy and cost savings. Awarded https://www.canstar.com.au/news-articles/2020-innovation-awards/
• Project: International Health Fraud Framework
• Aligned and implemented fraud framework across International Health business (Australia) to global Allianz Group requirements.
• Projects: Client Off boarding and Onboarding
• Ensuring claim readiness for new and ceased partners including activities in transitioning and communication to customers and clients and closing contracts
• Claims Quality Team
• Managed team of 7 senior claims specialist who audit claim outcomes and settlements. Developed reporting and regular communication with relevant teams to address issues identified, discuss trends, recommend process improvements to reduce leakage and increase accuracy.

• Recruited, trained, and managed local and offshore teams of 15+ staff at Thailand and New Zealand office; to service customers (both Australian and limited english proficient) and provide advice for 100+ Travel Insurance and International Health products
• Management of team performance including workflow distribution of enquiries, claims and complaints allocation to be processed within service level agreements, quality measures and regulatory standards
• Consistently maintained 80%+ turnaround time for claims payment processing with 95%+ accuracy standard
• 90% of emailed enquiries were triaged and responded to within 48 hours
• Identified ongoing improvements to key processes for internal controls and customer contact procedures
• Introduced standardized templating and scripting resulting in monthly increase in Net Promoter Score from 40% to 70%+ Customer satisfaction and overall improvement of Service Level Objectives.

• Managed and assessed portfolios of high value (20k +), complex and sensitive claims; including complex medical cases requiring hospital guarantees, repatriation, accidental death, permanent disability, and personal liability claims
• Assessed and processed overseas and local medical invoices and direct billers
• Reviewed claims for fraud and recovery under compensation or indemnity
• Managed escalated enquiries, complaints, and disputes to an effective resolution.

• Marketed and delivered services under Australian Government Hearing Services Program to local and eligible clients
• Managed budgets, appointment scheduling for audiologists, employee itineraries, site bookings and inventory accounts
• Managed office operations including staff recruitment, training, and ongoing coaching
• Maintained computer and physical filing systems
• Experienced in communicating with hearing impaired using basic sign language and use of national translating and interpreting services.