Open to opportunities

Vathiwe Dyantyi

@vathiwedyantyi

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Claims Administrator specializing in COIDA processing, compliance, and audit-ready documentation.

South Africa

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What I'm looking for

I’m looking for a claims and compliance role where accuracy, audit-ready documentation, and stakeholder communication matter. I want to manage cases end-to-end under SLAs, improve quality through reviews/training, and grow my financial and risk expertise.

I’m a detail-oriented Claims Administrator with over 5 years of experience across claims administration, claims assessment, quality assurance, and branch operations. I combine claims processing strength with quality, document verification, and clear stakeholder communication to keep cases accurate, compliant, and moving.

In my current role, I capture all injury/disease notifications under COIDA, send claim numbers to claimants and employers, and follow up on outstanding documentation to ensure timely acknowledgement and triage. I manage workflow claims (CAD pool), index and link documentation for audit readiness, accurately capture TTD, and coordinate branch administration as a Branch Custodian—overseeing petty cash reconciliation, service providers, and workplace compliance.

Earlier roles strengthened my audit and review mindset—assessing medical aid claims, conducting quality reviews of EMS reports with coding standards (e.g., ICD-10, HCPCS), and helping reduce denial risk through corrective actions and training. I’m also pursuing a BCom in Financial Management at UNISA to deepen my financial and risk thinking, supporting stronger decision-making in regulated environments.

Experience

Work history, roles, and key accomplishments

Current

Claims Administrator

Current

Rand Mutual Admin

Jul 2020 - Present (6 years)

Captured COIDA injury/disease notifications, followed up on outstanding documentation, triaged cases, and managed claims processing according to SLA requirements. Also handled branch-custodian responsibilities, including petty cash reconciliation, third-party service coordination, and workplace health and safety compliance.

SLA Management Claim Workflow Audit Readiness Total Temporary Disablement Petty Cash Management SharePoint Recordkeeping Visitor Logbooks

Quality Assurer

EMS Administrators

Sep 2018 - Jun 2020 (1 year 9 months)

Performed quality reviews of electronic Patient Care Reports to ensure billing and medical necessity standards for EMS claim submission. Audited for coding/protocol adherence (ICD-10, HCPCS), reduced denials/ disputes, and supported corrective actions and provider training.

Quality Assurance Patient Care Reports QA ICD 10 Coding Documentation Error Trend Analysis

Claims Assessor

Europe Assistance

Nov 2017 - May 2018 (6 months)

Assessed GEMS medical aid claims for compliance with policy provisions and accuracy of submitted information. Verified treatment necessity with medical professionals, analyzed claim data for trends/fraud risk, and communicated claim status updates to clients.

Policy Compliance Document Verification Medical Necessity Review Claims Data Analysis Client Communication

Paramedic (Basic Life Support)

Emuseni Paramedical Services

Apr 2017 - Nov 2017 (7 months)

Delivered Basic Life Support care in emergency situations and performed patient assessments. Documented patient information and trained junior staff on emergency response protocols.

Basic Life Support patient assessment Medical Documentation Teamwork Training

Supervisor

Kharigude (Department of Education)

Mar 2013 - Jan 2017 (3 years 10 months)

Oversaw daily departmental operations, ensuring compliance with educational regulations. Managed a team through training and performance evaluations, improving productivity and supporting process streamlining.

Operations Management Team Leadership Training Performance Evaluation Compliance Process Improvement Stakeholder Management Problem Solving

Education

Degrees, certifications, and relevant coursework

University of South Africa (UNISA)

Bachelor of Commerce (Financial Management), Financial Management

2025 -

Currently pursuing a Bachelor of Commerce in Financial Management. Developing advanced knowledge in financial management, accounting, taxation, budgeting, investment analysis, risk management, and financial reporting.

Octomate

LTI Level 4, Long-Term Insurance

2023 - 2023

Completed LTI Level 4 focused on long-term insurance products and policy administration. Covered FAIS compliance, risk management, ethics, and Treating Customers Fairly (TCF), including customer needs analysis and insurance sales techniques.

Growth in Motion

RE5 (FAIS Regulatory Examination for Representatives), Financial Advisory (FAIS)

2024 -

Successfully completed the FAIS Regulatory Examination for Representatives (RE5). Demonstrated understanding of the FAIS Act, General Code of Conduct, and Fit and Proper requirements to provide advice or intermediary services under regulated long-term insurance and related products.

University of South Africa (UNISA)

National Diploma, Public Administration and Management

2020 - 2023

Completed a National Diploma in Public Administration and Management, building foundations in organizational management, strategic planning, and administrative processes. Studied governance, leadership, and compliance principles with practical insight into financial and human resource management.