Claims Specialist

21 hours ago

Johannesburg Metropolitan Area, South Africa WatersEdge Solutions Full time

Claims Specialist

We are seeking a dedicated and detail-oriented
Claims Specialist
to join our growing team. This role is essential in delivering a seamless, client-centric claims experience within the funeral and insurance space. The successful candidate will be responsible for the end-to-end validation and finalisation of registered claims, ensuring that members receive the support they need during emotionally sensitive times.

As a key part of the Claims team, you will uphold our company's values by validating claims accurately, efficiently, and in line with policy wordings, quality standards, and regulatory frameworks.

Role Overview

  • Validate all registered claims, ensuring accuracy, completeness, and compliance with policy terms.
  • Prepare and reconcile validated claims for payment.
  • Ensure high levels of customer service, offering support and guidance to clients on claim queries.
  • Liaise with Claims Assessors, Supervisors, and Managers to resolve any discrepancies.
  • Meet required production and quality benchmarks as set by management.
  • Prepare and maintain daily claims metrics and reports.
  • Assist in fraud detection and investigations where required.
  • Conduct validations on Dionysus and follow standard operating procedures.
  • Contribute to ongoing training and upskilling within the team.
  • Ensure cross-functional collaboration with other departments on client claims.
  • Take ownership of the validation process and escalate issues as necessary.

Qualifications & Experience

  • Matric / NQF 4 minimum.
  • 3–5 years of experience in Claims Assessment or Claims Validation is essential.
  • Computer literate with strong working knowledge of Microsoft Office and Outlook.
  • Experience working on Dionysus or similar claims processing platforms is an advantage.
  • Strong communication skills; able to communicate effectively in English, Afrikaans, Zulu or Setswana (additional languages such as Xhosa, Tsonga, and Venda are a bonus).
  • Client-service driven with high attention to detail.
  • Strong interpersonal and problem-solving skills.
  • Team player who is punctual, honest, compassionate, and committed.
  • Willingness to work extra hours/overtime when required.
  • Ability to thrive in a fast-paced, process-driven environment.

What We Offer

  • Market-related salary based on experience.
  • Performance-based annual bonus.
  • Subsidised Life and Disability Cover.
  • Funeral Cover.
  • Opportunity to be part of a mission-driven team that delivers real impact to South Africans.

If you do not receive a response within 10 working days, please consider your application unsuccessful.

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