Donald Ayisala
Accra
Summary
Proven Claims Officer at First Premium Insurance, adept in claims analysis and fostering team collaboration. Excelled in reducing fraudulent claims and enhancing customer satisfaction through effective communication and investigative techniques. Streamlined claims processing, achieving significant efficiency improvements, while maintaining rigorous attention to detail and regulatory compliance.
Overview
5
5
years of professional experience
2
2
Certification
Work History
Claims Officer
First Premium Insurance
02.2022 - Current
- Managed high caseload efficiently, prioritizing tasks based on urgency and importance to meet deadlines consistently.
- Negotiated fair settlements with policyholders while maintaining positive relationships between the company and clients involved in disputes.
- Expedited claim resolution with prompt negotiation, evaluation, and settlement of claim amounts.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Minimized fraudulent claims by conducting thorough investigations and collaborating with law enforcement agencies.
- Prepared comprehensive reports for upper management detailing key findings from investigations into complex claim cases.
- Reduced claims processing time by streamlining documentation and communication procedures.
- Improved interdepartmental communication to expedite claims processing and foster a collaborative work environment.
- Maintained compliance with regulatory requirements by staying current on industry changes and updating policies accordingly.
- Conducted audits of closed claims to ensure accuracy, consistency, and adherence to company standards.
- Reviewed contracts thoroughly to ensure proper coverage for various types of insurance policies held by clients.
- Collaborated with legal counsel for effective litigation management, reducing costs and ensuring favorable outcomes.
- Implemented innovative strategies for reducing claim cycle time without compromising quality or accuracy of decisions made.
- Supported departmental goals by contributing ideas during team meetings aimed at refining processes within the organization.
- Followed up with customers on unresolved issues.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Evaluated and settled complex insurance claims in strict timeframes.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Notified insurance agents and accounting departments of policy cancellations and changes.
Education
Bachelor Of Science - Actuarial Science
University For Development Studies
Navrongo, GhanaGeneral Science
Opoku Ware Senior High School
Kumasi, Ghana04.2009
Skills
- Claims analysis
- Technical knowledge
- Investigation techniques
- Policy Interpretation
- Claims Investigation
- Teamwork and Collaboration
- Time Management
- Attention to Detail
- Multitasking
- Multitasking Abilities
- Organizing and Prioritizing Work
- Reliability
- Excellent Communication
- Organizational Skills
- Team Collaboration
- Active Listening
- Claims Processing
- Relationship Building
- Microsoft Office
- Team building
- Task Prioritization
- Goal Setting
- Professionalism
- Team Goals
- Insurance Plan Verification
- Calculator Proficiency
- Team Support
- Liability Determinations
- Client Satisfaction
- Service Quality
- Company Standards
Certification
I am very affluent with the English language and can express myself very well with it. My mother tongue is the English language and throughout my over 20 years in school, I have been thought and examined in english
Languages
English
Advanced (C1)
Timeline
Claims Officer
First Premium Insurance
02.2022 - Current
Bachelor Of Science - Actuarial Science
University For Development Studies
General Science
Opoku Ware Senior High School
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