Consultant: GD Adjudication X2

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-month, fixed-term contract position

Purpose of the job: The Consultant: General Damages Adjudication is responsible for the processing of claimant applications with regards to general damages adjudication.

Key Performance Areas

General Damages adjudication

• Review the claim against the general damages adjudication standards.
• Identify falsified general damages related injuries and report them.
• Confirm and record medical management recommendations.
• Apply relevant controls and tools to generate general damages offer, i.e., book of quantum.
• Calculate general damage product and make an offer.
• Process the offer to be communicated to the claimant following the appropriate channels.

Quality assurance

• Participate in the consultations process on the implementation of programs and services.
• Ensure that programs and services are implemented and maintained to the highest standards.
• Implement the development and implementation of an unusual occurrence procedures.

Administrative support.

• 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 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 a Health Sciences related qualification.

Experience

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

Technical and behavioral competencies required

• Claims assesment and settlement process and systems (including handling, general damages assessment and settlement)
• Medical case management
• Complex problem identification, solving and decision making
• Claims management processes and systems
• Customer value proposition
• Good financial management skills
• Strong analytical capabilities
• Knowledge of Motor Vehicle Accident legislation
• PFMA knowledge
• Planning, Organising and Coordinating
• Personal Mastery
• Judgement and Decision Making
• Ethics and Values
• Client Service Orientation

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.