Johannesburg: Claims Specialist posted by WatersEdge Solutions

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.