Claims Specialist

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

Job summary

A leading claims services provider seeks a dedicated Claims Specialist to ensure accurate validation and finalization of claims. You will provide exceptional client support in sensitive contexts, uphold quality standards, and collaborate with various teams to deliver on production benchmarks. The ideal candidate has 3-5 years of experience in claims assessment and strong attention to detail. This role offers a market-related salary and performance-based bonuses, creating a meaningful impact in the lives of South Africans.

Benefits

Market-related salary

Performance-based annual bonus

Subsidised Life and Disability Cover

Funeral Cover

Qualifications

• Minimum 3–5 years of experience in Claims Assessment or Validation.
• Strong working knowledge of Microsoft Office and Outlook.
• Willing to work extra hours or overtime when required.

Responsibilities

• Validate all registered claims, ensuring accuracy and compliance.
• Prepare validated claims for payment.
• Offer support and guidance to clients on claim queries.
• Assist in fraud detection and investigations.
• Maintain daily claims metrics and reports.

Skills

Claims Assessment

Customer Service

Attention to Detail

Communication Skills

Problem-solving

Interpersonal Skills

Microsoft Office

Education

Matric / NQF 4

Tools

Dionysus

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 elevate 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.