Francois Adam Cerveaux
Souillac,SA
Summary
A reliable, capable and enthusiastic individual who is able to collaborate with the management and coordinate duties of any leadership role. Possessing extensive experience to support, develop and motivate team members and drive them towards continuous improvements across a range of work activities. Has shown to be proactive and comes up with practical improvement initiatives which enhance a company's overall effectiveness.
Overview
25
25
years of professional experience
Work History
Claims Management Broking
Willis Towers Watson
01.2020 - Current
- Reviewed medical records and other documentation to accurately assess injury or property damage claims.
- Enhanced customer satisfaction with prompt and accurate claims processing.
- Established strong relationships with policyholders through clear communication and empathetic handling of sensitive situations.
- Mentored junior staff members on effective negotiation techniques, increasing overall success rates in dispute resolution.
- Increased workflow efficiency by automating routine tasks and optimizing resource allocation within the team.
- Managed a large caseload of diverse claims, ensuring accurate evaluations and timely resolutions.
- Leveraged industry expertise to provide guidance on complex claims issues, ensuring fair outcomes for all parties involved.
- Served as a liaison between insurance providers and clients during complex claim negotiations, facilitating positive outcomes for both parties.
- Maintained up-to-date knowledge of industry regulations and best practices, applying this knowledge to daily operations for optimal results.
- Managed escalated customer complaints regarding claims processing, applying problem-solving skills to resolve issues and maintain client satisfaction.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Evaluated and settled complex insurance claims in strict timeframes.
- Followed up with customers on unresolved issues.
- 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.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Documented information gathered in field and uploaded data to company database for efficient processing using OrganiseIT [DMS] And biais [Broking Platform].
- Improved claim resolution times by streamlining processes and implementing efficient workflows.
- Maintained claims data in OrganiseIT and ibais systems.
Assistant Claims Manager - Motor
Eagle Insurance Ltd
08.2017 - 06.2018
- To assist the Management of the Eagle Insurance Ltd to review and enhance their actual claims processes and risk management strategies.
- Managing and Monitoring of Motor Claims: Proactively monitor and manage claims from notification to closure, investing the necessary level of involvement required for each claim depending on, inter alia, the nature, category, maturity, type and quantum of the claim.
- Follow at all times established Claims Standards of Eagle Insurance Ltd.
- Develop, document and execute claims strategies taking into account uncertainties, key decisions, potential outcomes and estimated associated costs.
- Provide input to underwriters on review of potential or existing insured's claims experience.
- Feedback claims trends and developments and their potential impact on the book to underwriters.
- Suggest wordings improvements to underwriters.
- Work proactively to develop and manage strong relations with brokers, agents and direct clients.
- Manage a team of claim professionals and administrative staff.
- Report to management.
- Providing Training to staff on policy terms and conditions.
- Managing Fraudulent Claims with assistance of Independent Investigators, Legal Counsel and Police Authorities.
- Facilitated the resolution of escalated customer complaints through mediation efforts between both parties involved in the dispute.
- Implemented new technologies within the department to improve productivity and streamline daily tasks.
- Assisted in the development of improved guidelines for claim handling processes to increase overall efficiency.
- Maintained compliance of company policies and procedures through regular audits and staff training sessions.
- Coordinated regular departmental meetings to discuss ongoing projects, challenges, and opportunities for improvement.
- Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
Claims Manager
Palaos Ltd
06.2017 - 08.2017
- To help Palaos achieve their vision of providing the highest performing standards of insurance brokerage.
- Managing and Monitoring of Motor and Non Motor Claims: Proactively manage individual claims [Motor & Non Motor] from notification to closure, investing the necessary level of involvement required for each claim depending on, inter alia, the nature, category, maturity, type and quantum of the claim.
- Follow at all time Palaos Claims Standards
- Develop, iterate, document and execute claims strategies taking into account uncertainties, key decisions, potential outcomes and estimated associated costs.
- Provide input to underwriters on review of potential or existing insured's claims experience.
- Feedback claims trends and developments and their potential impact on the book to underwriters.
- Suggest wordings improvements to underwriters
- Work proactively to develop and manage strong relations with key insurers and insured's.
- Manage a team of claim officers.
Motor Claims Coordinator - Brokers
Swan General Ltd
06.2017 - 08.2017
- To handle, monitor and assess various claims for clients insured through an insurance broker.
- To verify and assess Total Loss Claims to be referred to Management and Total Loss Committee for approval.
- Also to monitor Total Loss Salvage.
- Verify and approve 2nd level payments within prescribed limit of Rs250, 000.
- To assist claim handlers with difficult claims and to reply to complaints.
- Assist Management with various projects relating to claims management process.
Senior Claims Officer
Mauritian Eagle Insurance Co. Ltd
04.2017 - 06.2017
- Responsible for supervising a team and ensuring that duties are completed within strict timeframes.
- Handling and Monitoring of Motor Claims: Mentoring of Team Members with reference to Claims Procedures, Terms and Conditions of the Motor Policy.
- Attend to motor claims.
- Meet, discuss and negotiate with clients [Direct, Agents or Brokers] for settlement of their claims.
- Assist clients in lodging of claim.
- Inform client of procedures to be followed.
- Record statements form clients/witnesses.
- Have good knowledge of the terms and conditions of the Company's Motor Vehicle Policies
- Monitor the day to day motor claims procedures and assist claims handlers with difficult and major claims
- Monitor claims recording and updating on Agilis, & Zedoc.
- Assess amount of claims payable.
- Adjust and negotiate claims for settlement.
- Ensure prompt payment to clients and/or any other party.
- Recovery Procedures: Follow up recovery actions after payment of claims.
- Prepare letters and reminders to Third Parties/ Third Party Insurers.
- Contact, discuss and negotiate with Third Party Insurers for recovery of amount due by them.
- Liaise with legal advisers - when necessary.
Motor Claims Handler (Supervisor)
Swan General Ltd
08.2015 - 04.2017
- Responsible for supervising a team and ensuring that duties are completed within strict timeframes.
- Handling and Monitoring of Motor Claims: Mentoring of Team Members with reference to Claims Procedures, Terms and Conditions of the Motor Policy.
- Attend to motor claims.
- Meet, discuss and negotiate with clients [Direct, Agents or Brokers] for settlement of their claims.
- Assist clients in lodging of claim.
- Inform client of procedures to be followed.
- Record statements form clients/witnesses.
- Have good knowledge of the terms and conditions of the Company's Motor Vehicle Policies.
- Monitor the day to day motor claims procedures and assist claims handlers with difficult and major claims.
- Monitor claims recording and updating on AS 400, ELO Archive & Visual Basics.
- Assess amount of claims payable.
- Adjust and negotiate claims for settlement.
- Ensure prompt payment to clients and/or any other party.
- Recovery Procedures: Follow up recovery actions after payment of claims.
- Prepare letters and reminders to Third Parties/ Third Party Insurers.
- Contact, discuss and negotiate with Third Party Insurers for recovery of amount due by them.
- Produce relevant reports to the Management.
- Monitor and update the recoveries and legal files on the existing IT system.
- Liaise with legal advisers - when necessary.
Motor Claims Handler and then Motor Underwriting Supervisor
Legacy Gras Savoye Brokers & Consultants Ltd
01.2009 - 08.2015
- Motor Underwriting Supervisor as from 2011 - Responsible for supervising a team and ensuring that duties are completed within strict timeframes.
- Review Renewal Rates, Excess, Terms and Conditions from insurers for both individual and corporate clients.
- Verify and sign Renewal Notices.
- Verify and Approve all Placing Slips and Policy Documents sent by insurers.
- Process Debit and Credit Notes.
- Follow up payment terms of certain debtors.
- Negotiate with Insurers for Renewal Terms for all Corporate Clients, analyse each client portfolio and prepare report for management.
- Prepare and analyse Motor Fleet Tenders and report to management.
- Writing reports for management and delivering presentations.
- Delegating work duties to individual team members.
Motor & Non Motor Claims Handler (Supervisor)
Swan Insurance Co Ltd
09.2007 - 12.2008
- Handling of Motor and Non Motor Claims: Attend to motor and non motor claims.
- Meet, discuss and negotiate with client's settlement of their claim.
- Assist them in lodging of claim.
- Inform them of procedures to be followed.
- Record statements form clients/witnesses.
- Have good knowledge of the terms and conditions of the Company's Motor and Non Motor Policies.
- Monitor the day to day claims procedures.
- Monitor claims recording and updating on AS 400 and Lotus Notes.
- Assess amount of claims payable.
- Adjust and negotiate claims for settlement.
- Ensure prompt payment to clients and/or any other party.
- Recovery Procedures: Follow up recovery actions after payment of claims.
- Prepare letters and reminders to Third Parties/ Third Party Insurers.
- Contact, discuss and negotiate with Third Party Insurers for recovery of amount due by them.
- Produce relevant reports to the Management.
- Monitor and update the recoveries and legal files on the existing IT system.
- Attend Court Hearings - when necessary.
- Liaise with legal advisers - when necessary
Claims Officer
Brokers and Consultants Co Ltd
03.2005 - 08.2007
- Handling motor and non-motor claims: Assist clients in preparing their claim.
- Negotiation and follow up of client's claims with insurance companies.
- Make sure that client is fully satisfied at claim settlement.
Motor Claims Officer
Mauritius Union Assurance Co Ltd
10.2000 - 02.2005
- My job consisted of negotiating with: Clients to have their vehicles repaired.
- The third party insurance company, if any, make the necessary arrangements to repair insured's vehicle and deal with the third party claims.
- The motor surveyor and garage concerning costs of repairs and spare parts.
- Approve repairs if necessary for either our insured vehicle or third party vehicles.
- Effect various payments for all expenses incurred after repairs.
- Continuous follow up of clients file until repairs to their vehicles are completed and clients fully satisfied.
Marine Underwriting Officer
Vigier De Latour Assurance Co Ltd
04.2000 - 09.2000
- Preparing marine insurance policies and sending them to the clients.
- Submitting new motor insurance policies and renewing clients' policies.
- Collecting debts from clients.
Education
No Degree - Higher School Certificate
La Confiance College
Beau-Bassin, Mauritius01.1999
No Degree - Form I-II
Moaka Junior Secondary School
Botswana 01.1995
No Degree -
Northside Primary School
Botswana01.1992
Skills
- Customer service
- Communication skills
- Time management
- Microsoft Office
- Teamwork and Collaboration
- Problem-Solving
- Policy Interpretation
- Customer Service
- Organizational Skills
- Team Collaboration
- Attention to Detail
- Problem-solving abilities
- Excellent Communication
- Critical Thinking
- Computer Skills
- Customer service and support
- Adaptability and Flexibility
- Verbal Communication
- Relationship Building
- Self Motivation
- MS Office
- Written Communication
- Settlement Negotiation
- Insurance policy knowledge
Qualifications
11/01/97, 11/01/99, Diploma through CII in course
Drawing and Painting, Reading, Music, Sports, Gaming and Swimming.
I having been drawing since I can remember; it brings me immense joy and piece when I am drawing using colored pencils to draw a tiger or to hold a brush and paint a scene in the African bushes with waterbuck. I enjoy reading the Bible, DC or Marvel comics and Manga. Love for music comes from by Dad and my Grandfather, I love music is all its spectrum - from Elvis Presley, Frank Sinatra, Cat Steven's, Dire Straits, Queen, Edith Piaf, Charles Aznavour, MJ, Snoop Dog, B.I.G, Drake, Sega, Seggae, Mozart, House...and many more. I collected all PlayStation consoles; just love to play. Sports is essential to keep my body, mind and soul balanced.
Languages
English, French, Creole
Native language
Timeline
Claims Management Broking
Willis Towers Watson
01.2020 - Current
Assistant Claims Manager - Motor
Eagle Insurance Ltd
08.2017 - 06.2018
Claims Manager
Palaos Ltd
06.2017 - 08.2017
Motor Claims Coordinator - Brokers
Swan General Ltd
06.2017 - 08.2017
Senior Claims Officer
Mauritian Eagle Insurance Co. Ltd
04.2017 - 06.2017
Motor Claims Handler (Supervisor)
Swan General Ltd
08.2015 - 04.2017
Motor Claims Handler and then Motor Underwriting Supervisor
Legacy Gras Savoye Brokers & Consultants Ltd
01.2009 - 08.2015
Motor & Non Motor Claims Handler (Supervisor)
Swan Insurance Co Ltd
09.2007 - 12.2008
Claims Officer
Brokers and Consultants Co Ltd
03.2005 - 08.2007
Motor Claims Officer
Mauritius Union Assurance Co Ltd
10.2000 - 02.2005
Marine Underwriting Officer
Vigier De Latour Assurance Co Ltd
04.2000 - 09.2000
No Degree - Higher School Certificate
La Confiance College
No Degree - Form I-II
Moaka Junior Secondary School
No Degree -
Northside Primary School
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