Consultant: Merits (X4) at Road Accident Fund

Key Performance Areas

Merits management

• Compare the data on the accident information Centre against the claim to determine RAF liability.
• Categorize merits assessment using RAF defined merits classification (driver/non driver).
• Thoroughly investigate the merits of a claim/assessment of the merits file.
• Apply merits scenarios and rules to determine merits outcomes.
• Complete all necessary checklists and apply application categorization rules.
• Determine the need for a referral to claims investigation unit for further investigation and analyze the outcomes
• Record merits outcome and generate the offer.
• Submit the offer-to-offer management for further communication to the claimant.

Quality assurance

• Quality assures the outcomes of liability determination and captures the reasons for disagreement.
• Ensure that merits processes are implemented and maintained to the highest standards.
• Maintain the implementation of an unusual occurrence procedure.

Administrative support

• Verify registered merits information against Accident data Centre.
• 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.

Qualifications

• Bachelor’s Degree/ Advanced Diploma in a Health Sciences or Law related qualification.

Experience

• Relevant 3 years’ experience in an insurance/ investigations/ claims related environment.