Consultant: General Damages at Road Accident Fund

Purpose of the Job:

The Consultant: General Damages Adjudication is responsible for or 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 at the highest standards.
• Implement the development and 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 riks.
• 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 and Experience

• Bachelor’s Degree/Advanced Diploma in Health Sciences related qualification to discipline.

Experience

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

Competencies

Behavioural:

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

Technical:

• Claims assessment 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.