Current Jobs at Road Accident Fund

Key Perfromance Areas

Field Case Management

• Activate an undertaking certificate and compile a case management report.
• Conduct a home visit and educate the claimant on offerings of the undertaking and explain the process to be followed.
• Conduct follow up assessments and make recommendations on claimants needs as per the assessment.
• Coordinate the referrals to service providers aligned to the claimants needs as per the undertaking certificate.
• Ensure successful integration of the claimant back to the family and educate the claimant and family on the condition of the claimant.
• Facilitate timely consultation with appropriate medical service providers.
• Provide vocational guidance and possible back to work opportunities.

Rehabilitation Services

• Monitor the rehabilitation of claimant post discharge.
• Monitor the drug utilisation and application review thereof.
• Assess the level of care giver and the financial implications/ salary thereof.
• Determine claimant needs and facilitate reasonable recommendations for home and car modifications based on the nature of the claimant’s medical condition.
• Coordination of admission and request the necessary authorisations as per the caregiver SOP and guidelines.
• Coordinate and facilitate transfer to the hospital for admission.
• Facilitate the appointment of caregivers between the claimant and the caregiver, provide guidance on the process.
• Coordinate the monthly submission of time sheets for payment processing.

Facilitate the accuracy and effective submission of invoices

• Ensure that accounts submitted to the fund from service providers are valid in terms of RAF guidelines and the Road Accident Fund Act.
• Assess and monitor claims invoices to curb over servicing or abuse and fraudulent claims.
• Ensure that the accounts are paid timeously, according to service level agreements.
• Ensure that services and treatments claimed for are accident related (related to the accident under consideration).
• Compare outcomes and cost of different therapeutic modalities and surgical techniques and the information provided is invaluable in developing guidelines for clinical management.

Reporting

• Compile and update case management reports for the injured.
• Provide a report on patient care and ongoing rehabilitation.
• Reporting on the service by service providers.

Stakeholder Management

• Drive the stakeholder interaction needed to facilitate the level of care.
• Maintain relations with different levels of health specialists to enable smooth interactions.
• Particate in the awareness of RAF case management services in the communities.
• Communicate with all levels of stakeholders.
• Participate in relevant external RAF activities and events.
• Ongoing engagements with service providers.

Qualifications

• Bachelor’s Degree or Advanced Diploma in Nursing/ Allied Health Professions or related qualification.
• Registration with the relevant Health Professions Council body.

Experience

• Relevant 4 years’ experience in the Medical environment.
• Experience in Managed Healthcare environment.
• Knowledge of ICD and CPT coding will be an advantage.
• Valid code 8 driving license.

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Key Performance Areas

Valuation of Outstanding Claims Provision

• Build, develop and assess models for reserving/valuation using appropriate techniques to ensure that the data is accurate, and that model processes are effective, efficient, of high quality, well documented and verifiable.
• Data manipulation to determine reserves.
• Development of an appropriate valuation model/method.
• Setting of valuation assumptions.
• Running the model and producing results.
• Applying sensitivity and scenario testing to the results.
• Producing the valuation report.
• Standardize the actuarial valuation report to Actuarial professional guidance.
• Oversee that the actuarial results are correctly interpreted and reported in the RAF’s quarterly and annual financial statements.
• Manage the whole actuarial valuation process.

Development and Management of Funding Model

• Data manipulation for modelling future projections.
• Development of an appropriate modelling method – deterministic and/or stochastic.
• Set projection or modelling assumptions.
• Running model and reporting on results.
• Producing report on required funding from National Treasury and demonstrating period required by RAF to become solvent.
• Oversee that the actuarial results are correctly interpreted and applied. 

Quotation of “Loss of Earnings” and “Loss of Support” Benefits for Motor Vehicle Claims

• Developing model and assumptions for benefit quotations.
• Data manipulation to state of quotation of loss of earnings or loss of support benefits – especially the model input.
• Running model to produce benefit results.
• Check quotation results actuarially for reasonability.
• Produce quotation report.
• Manage the quotation processing. 

Modelling of Regulatory Solvency Capital Requirements and Providing Technical Actuarial Information for ESB Reporting

• Use actuarial valuation results to compile the FSB report.
• Run a few model scenarios that are required for statutory reporting.
• Produce reports as appropriate.

 Providing Executives with Input to the Strategic Plan

• Apply the Funding Model for financial projections.
• Set of model assumptions to make them suitable for projection purposes.
• Run model for Strategic Plan results.
• Apply scenario and sensitivity testing to model results.
• Produce necessary report on findings and results.
• Responsible for correct interpretation and application of actuarial results.
• Oversee and manage all related process.

Providing Monthly Claims Statistics for Management Reporting

• Extract data and data reports from IT claim system.
• Provide results in statistical and graphical form to provide information for monthly, quarterly, half-yearly and annual management reporting. 

Actuarial Investigations

• Investigate mortality and morbidity experience to assist in setting the quotation of loss of earnings and loss of support benefits.
• Assist with expense investigation for the company budgeting purposes.
• Produce appropriate reports for different relevant users of investigation results.
• Oversee that the actuarial investigation results are correctly interpreted and applied.

 Manage Actuarial Department Risks

• Assist with reviewing and monitoring risk mitigating tasks or measures.

 Policy Review and Implementation

• Contribute to the development and implementation of departmental policy, procedures and processes.
• Keep up to date with effective policy and practice execution strategies.

Reporting

• Prepare and submit reports as and when required to provide progress updates and/or inform management decisions.
• Develop reports/ policies/ procedures and guide the process through the alignment of the documents to the overall RAF’s Strategy.
• Develop functional reporting systems, for management, projects or performance reporting.

 Stakeholder Management

• Facilitate and manage communication with relevant internal and external stakeholders in relation to investments and proactively and progressively manage the relationships.
• Manage relationships with vendors, service providers or procurement teams and ensure that all relevant procured items are invoiced and paid on time.
• Communicate with all levels of stakeholder contact.
• Represent the Fund in relevant external activities and events. 

People Management

• Ensure the sourcing, development and retention of a high-performance team.
• Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of the RAF. Manage the implementation of human capital processes and procedures to control/regulate workplace conflict and/or institute corrective measures and consultation processes to address deviations from standards.
• Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals.

Qualifications and Experience

• Bachelor’s Degree/ Advanced Diploma in Actuarial Science/ Mathematics related qualification.
• Postgraduate in Actuarial Science/ Mathematics related qualification will be an added advantage.
• At least eight (8) professional actuarial exam passes/ exemptions will be an added advantage.
• Relevant 6 - 8 years’ experience in Actuarial environment of which 2 years must have been on a management/ supervisory level

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Key Performance Areas

 People Management Reporting

• Analyse reporting needs to ensure a full understanding of report requirements.
• Ensure that reports are consistent with regulatory and business requirements.
• Generate and analyse exception reports.
• Prepare reports for submission to various departments on a monthly and quarterly basis.
• Prepare people management statistical analysis reports to assist management with decision-making.
• Generate statutory reports for both external and internal stakeholders.
• Ensure reports, data, and parameters are validated and aligned with other departments to ensure accuracy and consistency.

 Maintain Organisational Structure on SAP

• Act as the first point of contact for the organisational structure changes and requirements on SAP.
• Responsible for the creation, modification, deletion or any required changes to positions or organisational structure in SAP as per workforce planning provided by the business.
• Analyse the Organisation Management impact and provide recommendations.
• Keep an audit trail for all OM changes.
• Monthly maintenance and validation of the approved budgeted positions report.

Data analysis and governance

• Ensure data entered into the HCIS is accurate, complete, and compliant with organizational standards and legal requirements.
• Develop different databases of data set for efficient categorisation of data and reporting.
• Conduct regular audits to ensure data accuracy and integrity across all HR systems, communicating data issues to business owners for resolution.
• Implement data governance practices, including data validation, audit initiatives, quality checks, and troubleshooting data discrepancies.
• Integration and management of data.
• Identify, analyse, and interpret trends or patterns in complex data sets.

Functional and Business Support

• Collaborate with business to understand business requirements and translate them into effective HCIS analytics solutions.
• Participate in the implementation and continuous improvement of HCIS, including enhancements, upgrades, and integrations.
• Provide technical support and on job training to people management and related personnel on reporting and analytics functionalities within HCIS.
• Serve as a subject matter expert (SME) on HCIS tools and functionality.
• Document processes, maintain knowledge bases, and create user guides for HCIS and reporting tools.
• Analysis and review of HC systems processes and provide recommendation of improvements.

HR Systems Testing.

• Review test cases and test scripts and recommend changes.
• Perform user acceptance testing and quality assurance during systems upgrades/changes.
• Compile system testing packs for sign-off and deployment to production. 

Qualifications and Experience

• Bachelor’s Degree/Advanced in Information Technology/ Human Resources Management related qualification.
• SAP HCM Certification.
• SAP SuccessFactors People Analytics Certification will be advantageous.
• ITIL Certification will be advantageous.
• Power BI Certification will be advantageous.
• Relevant 4 years’ experience in a Human Capital Information Systems related environment of which 1 year must have been specialising in data management.
• Experience in People Management reporting.
• Experience in SAP SuccessFactors Analytics will be an added advantage.

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Key Performance Areas

Assessment of Injuries

• Assess extent of injuries on admitted patients.
• Daily assessment of patient according to prescribed measurements.
• Conduct daily patient scoring and data collecting.
• Monitor quality of care.
• Select and monitor clinical pathways.
• Identify patients’ needs.
• Identify and record pre-existing conditions.

Facilitate patient care

• Facilitate multi-disciplinary patient care where appropriate.
• Facilitate timely transfers into the appropriate levels of care.
• Coordinate the admission and pre authorisations of the transfers.
• Coordinate and provide necessary health education.
• Discharge planning and vocational guidance for the afterlife changing event for client
• Drug utilization review.
• Proper handover to Field Case Management for continuation of care.

Patient Advocacy

• Cost Benefits analysis of the medical services.
• Liaison between patient and care team to ensure common understanding and conflict resolution.
• Negotiate and procure resource services from providers.
• Ensure that patient confidentiality is maintained by all parties.

Facilitate the accuracy and effective submission of invoices

• Ensure that accounts submitted to the fund from service providers are valid in terms of RAF guidelines and the Road Accident Fund Act.
• Assess and monitor claims invoices to curb over servicing or abuse and fraudulent claims.
• Ensure that the accounts are paid timeously, according to service level agreements.
• Ensure that services and treatments claimed for are accident related (related to the accident under consideration).
• Compare outcomes and cost of different therapeutic modalities and surgical techniques and the information provided is invaluable in developing guidelines for clinical management.

Reporting

• Compile and update Hospital Case management reports.
• Recommend issuing of Undertaking Certificate.
• Provide a reasonableness report of patient care in prepation of the rehabilitation post discharge.

Stakeholder Management

• Communicate with all levels of stakeholders.
• Participate in relevant external RAF activities and events.
• Ongoing engagements with service providers.

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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.