Officer: Undertakings X 3 at Road Accident Fund

Key Performance Areas

Handle Claims

• Interpret the settlement, the undertaking and any limitations to determine the Funds liability for future costs to be incurred.
• Scrutinize past medical expenses to determine the Funds liability for future costs to be incurred.
• Identify any differences between the final settlements and re-draft the undertaking to reflect the correct liability.
• Take cognisance of all expert reports, of internal and external origin, to determine the following:
• The nexus between the costs incurred and the accident.
• The reasonability of the costs by comparing the costs incurred with the claimants personal circumstances and needs
• Communicate with experts where there is uncertainty i.r.o. costs incurred.
• Report any discrepancies to Senior Officer.
• Pre-authorise costs still to be incurred in terms of the undertaking within the mandate and in line with the medical and legal assessment.
• Recommend or approve payment of the costs as per the mandate; or repudiate the costs; or request more information or refer for medical intervention.
• Refer cases to field Case Managers for further investigation
• Determine the need for home visits and attend when required.
• Determine the need for the appointment of experts to do further assessments.
• Approve other officers payments on MIS which includes checking for duplicates and if the correct payee is being paid.

Update claims records

• Correct/update any change in the settlement details on the undertaking system to ensure that the liability of the Fund is accurately reflected on the system.

Manage Correspondence

• Draft legal correspondence to all external stakeholders.

Attend to queries

Attend to queries from internal and external stakeholders pertaining to the undertaking including the following:

• Liability of the Fund in terms of the undertaking.
• How to submit a claim.
• Status/progress made on the claims already submitted.
• General enquiries.
•  Give advice to stakeholders on legal issues pertaining to undertakings.

Manage Litigation

• Receive & record all litigation processes served in terms of the Undertaking.
• Evaluate the documents, consider the Funds legal position with regards to the process.
• Arrange for the matter to be held over, if necessary, alternatively.
• Appoint an attorney for the Fund to defend the matter.
• Refer the matter for assessment to determine the Funds liability.
• Negotiate settlement with the attorney, alternatively, consider the opinions from the attorney and give clear instruction to the Funds attorneys to reach settlement.
• Adhere to the time limits to prevent any wasted costs
• Attend to opinions from attorneys to ensure that the Fund is ready for trial when due.
• Report any risk to the senior to prevent any prejudice to the Fund.
• Arrange for interim disbursements to be attended to appropriately at Legal costs.
• Give proper instructions for settlement payments or payments in terms of court orders to prevent any unnecessary interest to be added.
• Arrange for the bill for costs to be referred to Legal costs to attend to and follow up on payment thereof.
• Report any actions from the Funds attorneys which is not in line with the Funds policies to the senior.

Compile Statistics

• Keep daily stats of activities on Undertakings and related matters.
• Submit daily stats and monthly stats as required by Management.
• Keep record of statistics.

Keep claims records

• Maintain record of all allocated matters.
• Maintain record of litigated matters.
• Maintain and apply a diary system used to pend matters to be followed up.
• Scrutinize incoming correspondence and maintain proper record thereof.
• Maintain proper record of files requested and returned to the I/S, referred to Medical and/or Administration cell.
• Keep record of private telephone calls and submit accurate telephone accounts on a monthly basis

Qualifications 

• NQF 7 (Bachelor’s Degree OR Advanced Diploma) related qualification to discipline.

Experience 

• Relevant 3 years’ experience in the claims environment