Marieta Luyke
Brisbane,Australia
Summary
With over 15 years of diverse experience across life, medical, and general insurance claims, I bring a deep understanding of claims lifecycle management, from lodgement through to adjudication and finalization. In my most recent roles at Austbrokers Comsure and Partners Life, I have demonstrated strong capabilities in assessing complex claims (including loss of income, medical, and liability), negotiating with insurers and third parties, and delivering exceptional customer service under pressure.
My background includes:
End-to-end claims management across multiple lines, including personal injury and income protection.
Proficient in policy interpretation, exclusions, and regulatory compliance.
Strong communication and empathy, with a track record of managing sensitive customer interactions.
CRM and systems fluency.
Team leadership and mentoring, having supported new staff, and streamlined operational workflows.
I am confident in my ability to contribute effectively to Sedgwick's client-centric claims philosophy, particularly
Overview
18
18
years of professional experience
Work History
Claims Officer
Austbrokers Comsure
, Brisbane
04.2024 - Current
- Provide a professional claims handling service to achieve best possible outcomes and claims experience for the client whilst managing day to day handling of claims from lodgement through to finalisation of all Motor claims, Property claims, Liability claims, Personal injury claims, Travel claims including Workers compensation claims.
- Initiative Influencing events actively and proactively to achieve goals; working effectively without supervision or close instruction; acting to achieve goals beyond minimum requirements; thinking constructively and presenting suggestions about improvements to the ongoing claim processing and the workplace.
- Communicating Ideas and Information Clearly expressing ideas both on a one-to-one basis and in group situations(including non-verbal communication); expressing ideas effectively in written format that contain correct and appropriate grammar, language, and terminology; adjusting language to suit the requirements of the recipients.
- Teamwork Demonstrating the ability to work effectively in a team/work group or those outside the formal line of authority (e.g. peers, senior managers), taking actions that respect the needs and contributions of others; contributing to, accepting and promoting the consensus; subordinating own objectives to the objectives of the organisation or team.
- Planning & Organising/Work Management Effectively manages ones' time and resources to ensure that work is completed efficiently and effectively; setting and achieving goals; establishing procedures to monitor the results of assignments or projects.
- Customer Service Orientation Developing customer relationships by listening to and making efforts to understand the customer (both internal and external, eg clients, suppliers, agents as well as other team members); anticipating and providing solutions to customer needs; prioritising customer satisfaction.
- Quality Orientation/Thoroughness Showing concern for completeness and accuracy around tasks, information, and project management. Accomplishing task with concern for all areas involved, no matter how small; maintain watchfulness over a period. Discovering weaknesses or missing data and acting to correct. Keeping track of many details without forgetting items.
- Negotiation Effectively exploring alternatives and positions to reach outcomes that gain all parties' support and acceptance. Presenting rational arguments, drawing on reason and logic in making a case; demonstrating that a course of action is of mutual benefit.
- BAU/Claims management Ensure all claims are lodged in a timely manner
- Communicate with all parties including Clients, third parties, Insurers, Assessors, and repairers to ensure a prompt and seamless experience for the client.
- Maintain accurate and complete records of claim at lodgement through Office Tech and CBS
- Ensure Insurance Advisers are kept informed as appropriate on the status of claims.
- Liaise and negotiate with Insurers and other providers to achieve the best possible outcome for the client.
- Ensure monthly claims reviews are updated and distributed.
- Ensure all procedures are adhered to with the respect to all action on a claim.
- Work effectively with team/work group and those outside of company.
Medical Claim Assessor
Partners Life
Auckland
01.2020 - 01.2024
- Proficiently evaluate, adjudicate, and make determinations on medical insurance claims, ensuring the accurate application of policy terms.
- Reviewing complex medical documentation, including medical records, diagnostic reports, invoices, and clinical notes including complex cancer treatment claims.
- Maintain a comprehensive understanding of insurance policy provisions, exclusions, and coverage limitations.
- Remain well-versed in the evolving landscape of insurance laws and regulations.
- Establish and maintain professional communication channels with policyholders, healthcare providers, and third-party intermediaries.
- Provide a superior level of customer service by promptly addressing inquiries and concerns and upholding a professional and customer-centric approach.
- Collaborate seamlessly with customer service teams and interdepartmental colleagues to enhance the overall customer experience.
- Foster a collaborative environment by actively contributing to a team of claims assessors, underwriters.
Long Term Claims Consultant
Fidelity Life
Auckland
12.2015 - 12.2019
- Proficiently and accurately process a wide range of life insurance claims, reviewing documentation to ensure compliance with company policies and regulatory requirements.
- Calculate benefit amounts and evaluate claim validity.
- Demonstrate a commitment to delivering customer service by promptly and addressing beneficiaries' inquiries and concerns, and guiding them through the claims process with empathy and professionalism.
- Communicate complex claim status updates, payment timelines, and documentation requirements to claimants, ensuring complete transparency.
- Maintain a comprehensive and organized record-keeping system, ensuring that all claim-related activities are documented and readily accessible.
- Enter claim data into the company's systems with precision, minimizing errors.
- Enter and update client information in the company's database or CRM systems.
- Extensive understanding of Fidelity Life's insurance products, policies, and underwriting guidelines.
- Uphold standards of compliance, ensuring that all claim processes strictly adhere to both internal company policies and industry regulations.
- Oversee the timely disbursement of claim payments, collaborating with financial institutions to facilitate fund transfers and issuing payments via checks or electronic methods.
- Conduct investigations into contested claims employing a methodical approach and adhering to legal and company guidelines.
- Collaborate with cross-functional teams, including legal and underwriting departments, to navigate complex claim scenarios and resolve disputes with integrity.
- Play an integral role in training and mentoring new team members.
- Conduct quality checks and reviews for claim-related documentation, payments, and reports.
- Demonstrate commitment to the confidentiality and security of sensitive personal and financial information, ensuring strict adherence to data protection and privacy protocols.
- Successfully address and resolve exceptions, discrepancies, and intricate situations that may arise during the claim processing journey.
Employee Benefit Administrator
Mercer Marsh
Auckland
06.2014 - 11.2015
- Renewals for allocated portfolio clients, Reconciliations, Underwriting, Claims processing, Quoting, Invoicing (Eglobal), Initializing projects to ensure streamline workflow, Excel Database management, Quality Framework, File Transfers, Travel Insurance policy issuing and various other General administration duties.
Team Leader/Senior Administrator
CommRisk Life
South Africa
03.2012 - 05.2014
- Senior New Business Team Leader for brokerage and Administrator.
- Managing New Business Hub for brokers/advisers, Health insurance Representative/Consultant and Medical Schemes.
- Advanced Quoting on Life, Income Protection, and health insurance.
- Liaising with Clients, brokers, and insurance companies.
- Personal Assistant to Director.
- Function Arrangements.
- Travel arrangements for brokers/advisers.
- Daily Diary management.
- Preparations for Brokers daily appointments.
- Commission statements management for various companies with commission Reconciliation between 6 Advisors on a monthly basis.
- Database management.
Health Insurance Administrator
Hausberger & Associates
South Africa
09.2010 - 02.2012
- Managing and representative for the entire Health book for the company.
- New business processing and Managing new business hub for all medical insurance.
- Servicing Requests.
- Liaising and relationship-building with all clients on a daily basis.
- Advanced Quoting and comparative Quoting.
- Assistant in Personal lines insurance (Qualified 30 credits approved representative).
- Developing Filing system for paperless office.
- Claims processing.
- Database management on CRM Systems.
Office Manager/Senior Administrator
Afken Financial Services
South Africa
06.2007 - 05.2010
- Office Manageress to 7 staff members.
- Smooth running of Admin Hub on a daily basis.
- Liaising with Brokers/clients on a daily basis and problem-solving.
- First point of contact for all clients/advisers for complaints, escalations.
- Distributing daily tasks to staff members.
- Checking accuracy on staff members processing of all work.
- KPI' Settings and management.
- Advanced Quoting/comparative Quoting.
- Claims processing.
- Preparation of client documentation.
- Preparation of Broker appointment packs with insurance details.
- Target management with Advisers and Admin Staff.
- Commission statements management and Reconciliation between 5 Advisors on a monthly basis.
- Training for all staff members and new staff.
- Upskilling.
- Time Management.
- Very busy brokerage with fast workspace.
Education
Grade 12 Matriculated -
Florida Highschool
Florida12.1999
RFP1 NQF Level 5 - Registered Financial Planning
Financial Planning Institute
JohannesburgSkills
- Customer service
- Administration
- Service quality
- Claims management
- Microsoft Office
- CRM systems
- Excellent verbal communication
- Excellent written communication
- Excellent communication skills
- Multi-tasking
- Telephone skills
- Relationship building
- Problem solving
- Planning
- Organizational skills
- Time management
- Cross-cultural
- Policy interpretation
- Documentation accuracy
- Regulatory compliance
- Conflict resolution
- Claims analysis
- Investigation techniques
- Fast learner
Accomplishments
- Current Club Netball player (>6 years in New Zealand and Australia) for Northlakes Blues (Club)
- Current Social Indoor Netball Player for 2 X Indoor Social teams at Northside Indoor Netball
- Netball Coach - @ schools and clubs - 2016 - 2023 - New Zealand
- Netball Player (2014 - Current) - Auckland and Christchurch
- Netball Player (2002 - 2009) - First League Indoor Netball South Africa
- Ringball Player (1997 - 2010) - South Africa
Languages
- English, Advanced (C1)
- Afrikaans, Proficient (C2)
Timeline
Claims Officer
Austbrokers Comsure
04.2024 - Current
Medical Claim Assessor
Partners Life
01.2020 - 01.2024
Long Term Claims Consultant
Fidelity Life
12.2015 - 12.2019
Employee Benefit Administrator
Mercer Marsh
06.2014 - 11.2015
Team Leader/Senior Administrator
CommRisk Life
03.2012 - 05.2014
Health Insurance Administrator
Hausberger & Associates
09.2010 - 02.2012
Office Manager/Senior Administrator
Afken Financial Services
06.2007 - 05.2010
Grade 12 Matriculated -
Florida Highschool
RFP1 NQF Level 5 - Registered Financial Planning
Financial Planning Institute
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