Consultant: LOS Adjudication X3

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: Loss Of Support Adjudication is responsible for the processing of claimant applications with regards to loss of support adjudication.

Key Performance Areas 

Loss of support adjudication

• Review the claim against the loss of support adjudication standards.
• Assess loss of support supporting documents and data to determine the deseased duty to support (confirming affirnity).
• Determine deceased ability to support the dependants by assesing income supporting data/documents in line with the approved quantum.
• Apply applicable case laws and Statutory limit to determine the LOE quantum.
• Based on the findings make a determination to reject or approve.
• Assess actuarial reports and make a determination to whether to instruct internal actuarial team to make actuarial calculation or not.

Quality assurance

• Research, analyse, and review policies and laws relevant to assigned cases
• Participate in the consultations process on the implementation of claims and related processes.
• Ensure that LOS Adjudication and processes are implemented and maintained at the highest standards.
• Maintain the implementation 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 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 and Experience

• Bachelor’s Degree/Advanced Diploma in a related qualification to discipline
• Relevant 3 years’ experience in a claims adjudication related environment.

Technical and Behavioural Competencies Required

• Planning, organisation and coordinating
• Personal mastery.
• Judgement and Decision Making
• Ethics and values.
• Client service orientation
• 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
• Interpersonal relations
• PFMA knowledge.

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.