Consultant: GD Adjudication X2 at Road Accident Fund

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