Consultant: Loss of Earnings: Adjudication at Road Accident Fund

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.