Claims Specialist

WatersEdge Solutions; Johannesburg; On-site; ZAR 200 000 - 300 000; Full time

Job summary

An established industry player is looking for a dedicated Claims Specialist to enhance their client-centric claims process in the funeral and insurance sector. This role involves validating claims, ensuring compliance with policy terms, and providing exceptional customer service during sensitive times. The successful candidate will work collaboratively with a mission-driven team, contributing to the overall success of the organization while making a meaningful impact in the lives of clients. If you are detail-oriented, client-service driven, and thrive in a fast-paced environment, this opportunity is perfect for you.

Benefits

Market-related salary

Performance-based annual bonus

Subsidised Life and Disability Cover

Funeral Cover

Mission-driven team environment

Qualifications

• 3–5 years of experience in Claims Assessment or Validation is essential.
• Strong communication skills in English and other languages are a plus.

Responsibilities

• Validate registered claims for accuracy and compliance with policy terms.
• Prepare claims for payment and assist in fraud detection.

Skills

Claims Assessment

Claims Validation

Communication Skills

Interpersonal Skills

Problem-Solving Skills

Attention to Detail

Education

Matric / NQF 4

Tools

Dionysus

Microsoft Office

Outlook

Job description

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.