Summary
Overview
Work History
Education
Skills
Interests
Timeline
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Helen Tessema

Brisbane,QLD

Summary

Dynamic Claims Specialist with IAG Insurance, adept at reducing claim processing errors through meticulous investigations and strong analytical skills. Recognised for exceptional customer service and effective negotiation, fostering client trust and satisfaction. Proven ability to lead teams and enhance productivity while maintaining compliance and quality standards in a high-pressure environment.

Overview

14
14
years of professional experience

Work History

Claims Specialist

IAG Insurance
09.2018 - Current
  • Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organisation.
  • Collaborated with cross-functional teams to optimise claims handling procedures, resulting in improved productivity.
  • Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
  • Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
  • Delivered comprehensive training sessions for new hires on claims handling procedures, policy interpretation basics, negotiation techniques, and other core competencies related to the role of a Claims Specialist.
  • Implemented customer feedback mechanisms to identify areas for improvement in claims process, leading to strategic enhancements.
  • Enhanced accuracy of claim assessments by adopting advanced analytical tools, leading to more informed decision-making.
  • Conducted regular audits of claim files, ensuring compliance with internal and external regulations and standards.
  • Analysed claim documents to ensure accuracy and compliance, mitigating risk of financial loss.
  • Provided expert advice on complex claim issues, aiding in resolution of high-stakes disputes.
  • Excellent communication skills, both verbal and written.
  • Passionate about learning and committed to continual improvement.
  • Complaint management
  • Adaptable and proficient in learning new concepts quickly and efficiently.
  • Managed time efficiently in order to complete all tasks within deadlines.
  • Demonstrated respect, friendliness and willingness to help wherever needed.
  • Worked well in a team setting, providing support and guidance.
  • Self-motivated, with a strong sense of personal responsibility.

Claims Team Leader

IAG Insurance
06.2018 - 09.2018
  • Ensured accurate documentation of all claim-related activities for compliance purposes.
  • Established a positive work environment through effective communication and teamwork.
  • Conducted regular audits of claim files to ensure quality control measures were being adhered to consistently across the team.
  • Fostered a culture of continuous learning by actively encouraging professional development opportunities for team members, resulting in a more knowledgeable and skilled workforce.
  • Collaborated with other departments to improve overall company performance in claims handling.
  • Handled escalated customer complaints, resolving issues promptly and professionally to maintain client satisfaction levels.
  • Communicated with staff, leaders and peers to coordinate successful collaboration with other departments.
  • Examined claims forms and other records to determine insurance coverage.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Conducted day-to-day administrative tasks to maintain information files and process paperwork.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
  • Identified suspicious losses and contacted manager for investigative assistance.
  • Clarified coverage of losses to policyholders and provided assistance in itemising damages and finding alternative living arrangements.

Claims Consultant

IAG Insurance
11.2011 - 05.2018
  • Managed large caseloads effectively, prioritising tasks to ensure prompt attention to urgent matters.
  • Resolved complex claims, utilising expert knowledge of policy coverage and industry regulations.
  • Provided expert advice on coverage limits and exclusions, helping clients make well-informed decisions about their insurance needs.
  • Negotiated favourable settlements for clients, maintaining a high success rate in claim resolutions.
  • Maintained strong relationships with clients, fostering trust and loyalty through excellent communication skills.
  • Trained new hires on claims procedures, ensuring a seamless transition into their roles as Claims Consultants.
  • Enhanced client satisfaction by providing timely updates on claim status and offering personalised support.
  • Reduced claim resolution time with thorough investigations and effective negotiation techniques.
  • Facilitated smooth communication between all parties involved in the claims process – from clients to adjusters – resulting in efficient resolutions without undue delays or setbacks.
  • Followed up with customers on unresolved issues.
  • Evaluated and settled complex insurance claims in strict timeframes.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Analysed information gathered by investigation and reported findings and recommendations.
  • Followed up on potentially fraudulent claims initiated by claims representatives.
  • Assisted homeowners by coordinating vendor services, emergency repair, cleaning and contractors.
  • Examined claims forms and other records to determine insurance coverage.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Conducted day-to-day administrative tasks to maintain information files and process paperwork.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Reviewed police reports and physical property damage to determine extent of liability.
  • Identified suspicious losses and contacted manager for investigative assistance.
  • Clarified coverage of losses to policyholders and provided assistance in itemising damages and finding alternative living arrangements.

Education

Bachelor of Science -

University of Auckland
Auckland, New Zealand
05-2010

Skills

  • Claims processing
  • Claims investigation
  • Verbal communication
  • Settlement determinations
  • Documentation review
  • Inspection report review
  • Claims trend analysis
  • Settlement coordination
  • Forms validation
  • Settlement management
  • Decision-making
  • Time management
  • Critical thinking
  • Customer service
  • Teamwork and collaboration
  • Multitasking Abilities
  • Problem-solving
  • Negotiation
  • Multiple taksker
  • Policy interpretation
  • Compliance management
  • Microsoft office
  • Coverage assessments
  • Claims analysis
  • Attention to detail
  • Team building
  • Active listening
  • Coverage determination
  • Regulatory compliance adherence
  • Reporting skills
  • Written communication
  • Analytical thinking
  • Policy review
  • Teamwork
  • Problem-solving abilities
  • Multitasking
  • Reliability
  • Excellent communication
  • Adaptability and flexibility
  • Verbal and written communication
  • Interpersonal skills
  • Conflict resolution
  • Tableau analysis and reporting
  • Fraud detection
  • Complaint management
  • Training delivery
  • General Insurance
  • Coaching and Mentoring
  • Technical Writing
  • Quality Auditing

Interests

  • Volunteer Work
  • Volunteering for community initiatives to give back to local communities and make a positive impact
  • Cooking
  • Dancing
  • Baking

Timeline

Claims Specialist

IAG Insurance
09.2018 - Current

Claims Team Leader

IAG Insurance
06.2018 - 09.2018

Claims Consultant

IAG Insurance
11.2011 - 05.2018

Bachelor of Science -

University of Auckland

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Helen Tessema