Officer: Undertakings x4 - Menlo Park, Gauteng, ZA 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 settlement 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
• 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 & Experience

• NQF 7(Bachelor’s Degree OR Advanced Diploma) related qualification to discipline.
• Relevant 3 years’ experience in the claims environment.