Senior Officer at Road Accident Fund

Key Performance Areas

Claims Handling

• Ensure the correctness of the interpretation of the settlement, the undertaking, any limitations and or the past medical expenses to determine the Funds liability for future costs to be incurred.
• Ensure that any discrepancies are corrected by the redrafting of the undertaking to reflect the correct liability.
• Ensure that cognisance is taken of all expert reports, of internal and external origin, as well as the Medical and Legal assessment to determine the Funds liability for the costs incurred.
• 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.
• Ensure that matters are referred to field Case Managers for further investigation.
• Ensure that the need for home visits are timeously identified and attended to when required.
• Ensure that the appropriate experts are appointed to do further assessments.
• Ensure the accurate quantification of undertakings. 

Perform undertakings information audit

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

Ensure appropriate Correspondence on undertakings

• Ensure the drafting of legally correct correspondence to all external stakeholders.
• Ensure the drafting of legally correct contracts for the quantification of Undertakings.
• Ensure the drafting of legally correct contracts for the partial and/or buy-out and new undertaking.
• Ensure the re-issue of legally correct undertakings. 

Perform advisory function

• Ensure that queries from internal and/or external stakeholders pertaining to the undertaking are attended to timeously & correctly.
• Ensure that stakeholders are given legally sound advice on legal issues pertaining to undertakings.

Litigation

• Ensure that the Fund is not prejudiced by way of litigation instituted in terms of the undertaking.
• Ensure that Management is timeously informed of any risk to prevent any prejudice.
• Ensure that the Funds attorneys act in line with the Funds policies. 

Collate and compile statistics

• Keep daily stats of activities on Undertakings and related matters.
• Compile daily and monthly reports as required
• Keep record of the statistics.

Office administration

• Ensure that all matters are properly pended and followed up timeously.
• Ensure that all matters allocated are recorded.
• Ensure that all litigated matters are recorded.
• Ensure that all incoming correspondence are scrutinized and ensure that proper record is kept thereof.
• Ensure that proper record is kept of files requested and returned to the I/S, referred to Medical and/or Administration cell.
• Keep proper record of all complaints received and attended to.
• Keep proper record of all reports/memorandums/instructions etc.
• Control and query telephone lists on a monthly basis.
• Monitor staff availability on a daily basis.

Human Resources

• Identify training needs of personnel and satisfies those needs by means of direct training or refer to a third party to do the training.
• Ensure that all staff are informed of new directives, policies, guidelines, instructions.
• Ensure that staff follow and abide by the conditions of service.
• Ensure that claims received a dealt with timeously and correctly.
• Manage staff availability.
• Performs the necessary inspections and controls on files and computer records.
• Assess and appraise the performance of subordinated on a continuous basis.

Qualifications

• Bachelor’s Degree @ NQF Level 7 in law or equivalent.

Experience

• Relevant 4 years’ experience in the claims environment of which 1 year is on supervisory level
• Admitted as an attorney in a legal practice and basic knowledge of medical terminology will be advantageous.