Consultant: loss of earnings: Adjudication

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.

Note: This is a 12 Months Fixed Term Contract

Purpose of the Job: The Consultant:  Loss of earnings- Adjudication is responsible for the processing of claimant application with regards to loss of earnings.

Key Performance Areas

Loss of earning adjudication

• Confirm and record medical management recommendations.
• Review the claim against the loss of earnings adjudication standards.
• Check injury documents substantiating an ability to earn an income and make a determination.
• Analyse the age, qualification level and skillset of the claimant to determine whether   the applicant qualifies for an LOE.
• Make a determination on the whether the injured is able to earn income or not as well as whether the injured is major or minor.
• Apply applicable case laws and Statutory limit to determine the LOE quantum.
• Schedule the injured for medical assessment in line with the findings.
• Make recommendations on an appropriate amount of money for pay out per case.

Quality assurance

• Adjucate the LOE product claim in line with the approved policy /SOP.
• Participate in the consultations process on the implementation of programs and services.
• Ensure that programs and services are implemented and maintained at the highest standards.
• Implement the development and implementation of an unusual occurrence procedures.
• Quality assure the loss of earning claims before they can be progressed to the next phase of the claims processing.

Administrative support

• Record and document proof affirnity.
• 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 risk.
• 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.
• Respond to queries within the predefined turnaround times.

Qualifications

• Bachelor’s Degree/Advanced Diploma in related qualification.

Experience

• Relevant 3 years’ experience in claims adjudication related environment.

Competencies

Behavioural:

• Planning, Organisation and coordinating.
• Personal mastery.
• Judgement and Decision Making
• Ethics and values.
• Client service orientation.

Technical:

• Claims management process/processes and systems.
• 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.

Road Accident Fund Values

• Integrity
• Compassion
• Accountability
• Respect
• Excellence
• Empathy.

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.