Claims Specialist

Direct message the job poster from Waters Edge Solutions

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.

• 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 escal

• 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.

• 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.

Associate

Full‑time

Administrative

Financial Services and Insurance