Consultant: Merits

The Road Accident Fund’s mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.

NB: This is a 12 Month’s Fixed Term Contract Position.

Purpose of the Job: To assess merits to determine RAF liability and obtain information from various stakeholders in order to assess the merits for claims.

Key Performance Areas

Merits management

•  Compare the data on the accident information Centre against the claim to determine RAF liability.
• Categorize merits assessment using RAF defined merits classification (driver/non driver)
• Thoroughly investigate the merits of a claim/assessment of the merits file
• Apply merits scenarios and rules to determine merits outcomes.
• Complete all necessary checklists and apply application categorization rules.
• Determine the need for a referral to claims investigation and analyze the outcomes.
• Record merits outcome and generate the offer.
• Submit the offer to offer management for further communication to the claimant.

Quality assurance

• Quality assure the outcomes liability determination and capture the reasons for disagreement.
• Ensure that merits processes are implemented and maintained at the highest standards.
• Maintain the implementation an unusual occurrence procedures.

Administrative support

• Verify registered merits information against accident data Centre.
• Deal with/and respond to correspondence.
• Produce documents, briefing papers, reports and presentations.
• Assist with typing and editing briefs, technical papers, letters to various parties, and memos.

Reporting

•  Track and report against set objectives and targets.
• Report on emerging risks.
• Provide ad hoc reports on process improvement initiatives.

Stakeholder management

• Maintain healthy relationships with all stakeholders.
• Follow up and resolve all queries, following up and making recommendations on which corrective actions are appropriate.
• Follow up and feedback to all stakeholders to keep them updated on the status of a query.

Qualifications and Experience 

• Bachelor’s Degree / Advanced Diploma in a Health sciences or Law related qualification.
• Relevant 3 years’ experience in an insurance/ investigations/Claims related environment.

Technical and behavioral competencies required.

• Planning, organizing and coordinating.
• Personal mastery
• Judgement and Decision Making
• Ethics and Values
• Client Service Orientation
• Understanding of post claim management and settlement.
• Medical bill reviewing
• Medical case management
• Complex problem identification, solving and decision making.
• Customer value proposition
• Good financial management skills
• Strong analytical capabilities
• Knowledge of Motor Vehicle Accident legislation.
• PFMA knowledge
• Knowledge of budgeting, sales, business development, and strategic planning.

Road Accident Fund Values

• Integrity
• Compassion
• Accountability
• Respect
• Excellence

NB: “RAF offers Total Employment Cost packages with no additional contributions from the Employer, successful candidates are required to structure their packages in a manner that will suit their needs”

The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.

Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful

Security Vetting shall be conducted on all prospective employees

It is the applicants’ responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.