Johannesburg: Claims Specialist posted by WatersEdge Solutions
Posted on 2025-04-29 00:00:00
| Employer | WatersEdge Solutions |
|---|---|
| Category | Other Finance/Accounting |
| Location | Gauteng / Johannesburg |
Job Summary
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 companys 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.
- 35 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.
Click Go Apply to apply online!
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