Hot Jobs at Road Accident Fund

Key Performance Areas

Medical Management

• Manage medical assessments including injury assessments of past and future medical care, preauthorization and clinical coding.
• Manage the assessment of the seriousness of medical injuries and determination of future care.
• Manage the implementation of the tariff, cost savings initiative recording and treatment protocol to ensure that all service providers adhere to the rules, and the tariff as guided by the RAF.

Exception Handling

• Develop tracking methods to report analysis results in business case scenarios.
• Manage the development and maintenance of formal exception handling process within the medical management unit.
• Manage the documentation and regular updating of the exception handling process.

Policy Review and Implementation

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

Reporting

• Prepare and submit regulation 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 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.

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.
• Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals.

Qualifications and Experience

• Bachelor’s Degree/ Advanced Diploma in Health Sciences or Medical related qualification.
• Postgraduate in a Health Sciences or Medical related qualification will be an added advantage.
• Registration with HPCSA/ SANCA.
• Relevant 6 - 8 years’ experience in a Medical Management related environment of which 2 years must have been on a management/supervisory level/ area of expertise.

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Key Performance Areas

Network Administration and Monitoring

• Maintain connection to or from different sites (WAN).
• Maintain backup links.
• Monitor and support Software Defined WAN (SDWAN) including internet connectivity systems, routers, switches, and related monitoring tools.
• Perform daily checks to ensure the high-level health of the network infrastructure.
• Support the Engineer: Infrustracture Operations on execution of network related projects.
• Maintain appropriate, recoverable network implementation supporting documentations.
• Update and monitor network device asset register and network protocols
• Monitor network software firmware.
• Support network cabling provider during installation of network data points.

Firewall and Infrastructure Security Related Services

• Maintain state of Firewall and all Infrastructure security tools.
• Monitor firewall logs and send them to ICT Security team for analysis.
• Perform firewall rules cleanup.
• Monitor Network security infrastructure devices.

Standards, Procedures and Policies

• Comply with approved standards for network services and operation.
• Comply with Information Security standard for network and firewall management.
• Provide network access to systems as per approved Information Security policy.
• Prepare and maintain any network related documentation.
• Continuously seek to improve network performance.

Provision of User support to Business

• Provides 1st and 2nd line support for incident management including incident closure.
• Resolve all incidents logged with agreed SLA with the business.
• Monitor and manage incident logged to ensure adherence to SLA’s.
• Identifies; tracks and resolves system problems.
• Escalates system problems/ opportunities for effective resolutions.
• Deal with inquiries and requests for information from both internal and external stakeholders.

Qualifications and Experience

• Bachelor’s Degree/ Advanced Diploma in Information Technology/ Computer Science related qualification.
• Cisco Certified Network associate (CCNA) and/or Network+,
• Certified Cisco Network Administrator, CompTIA and Microsoft preferred.
• Certified Operational framework like ITIL v3 or 4 process.
• Possession of a Huawei Certified ICT Associate (HCIA) and AWS and/or Azure certification will be an added advantage.
• Relevant 3 years’ experience in Networks and Security operations.
• Experience in Cisco Firewalls, Cisco Routers, Extreme Switches, relevant hardware and software applications as assigned, TCP/IP, DNS, OSPF, BGP and etc.
• Experience in monitoring and supporting networking equipment including network circuits, routers, switches, servers and monitoring tools to ensure network connectivity and availability.
• Experience in the implementation, tunning and managing networking technology infrastructure.

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Key Performance Areas

Integration Architecture

• Facilitate establishment of Architecture Standards and Policy.
• Develop EA standards, data architecture standards, EA governance frameworks, and system integration standards.
• Develop and maintain the technology stack to include commercial or open source integration platforms.
• Provide expert advice to project teams on use of integration technology, data architecture and modeling, system architecture including integration best practices
• Provide oversight in standards adherence through reviews of project work including detailed technical specifications and application code.
• Works with EA peers (e.g., enterprise, business, information, solutions and security architects) to analyse enterprise business context (business strategy and trends), as well as change requirements in other enterprise architecture viewpoints (such as business, information and solution) to derive the future state technology architecture. This includes defining the requirements, principles and models that guide technology decisions for the enterprise.
• Work with project teams in definition of requirements for integration strategies of their projects into the Enterprise Architecture.
• Oversee development and support of batch and back-end processes related to the application portfolio.
• Partner with leaders of other disciplines to ensure proposed solutions align with information, technology, infrastructure, business and security architectures.
• Develop conceptual integration & security architecture.
• Perform advisory service to business on solution building blocks.

Manage Integration Architecture Portfolio

• Develop an application integration portfolio.
• Periodically update the application integration portfolio to keep abreast of the changing application landscape.

Manage Integration Architecture

• Develop conceptual integration & security architecture.
• Perform advisory service to business on solution building blocks.

Identify Risks Associated with Solution Architecture

• Identifies existing business risks related to the implementation of software design.
• Draw up risk mitigation plan.

Policy Review and Implementation

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

Reporting

• Prepare and submit regulation reports as and when required to provide progress updates and/or inform management decisions.
• Develop functional reporting systems, for management, projects or performance reporting.

Stakeholder Management

• Communicate with all levels of stakeholder contact.
• Represent the Fund in relevant external activities and events.

Qualifications and Experience

• Bachelor’s Degree/ Advanced Diploma in Information Technology/ BSC Computer Science related qualification.
• TOGAF certification will be advantageous.
• Integration/ Service Oriented Architecture Certification will be advantageous.
• Relevant 5 - 7 years of relevant work experience in applications intergration/ management.
• Expertise in solution design and development, vendor management, enterprise application support, in addition to strong business understanding and project management.
• Experience in managing relationships with vendors/ consultants, IT teams and internal stakeholders.
• Experience working with API’s from commercial software applications.
• Experience in a management or supervisory role on an integration development team ould be an added advantage.

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Key Performance Areas

Development of Bill Review Rules and Guidelines

• Provide input into the development of guidelines to review medical bills in accordance to the fee schedule and internal processing guidelines.
• Research into the RAF Serious injury, the relevant CPT and ICD codes, unit standards and cost.
• Identify all the relevant medical codes (ICD 10, CPT, Tariffs, etc) which need to be updated, within bill review scope.
• Updating the Bill Review rules in collaboration with the clinical research team.

Audit and Review Medical Bills

• Accuracy of Bill review standards on cross-walked ICD and CPT application on invoice assessments.
• Report on bill reviewed cases for the organization, and cost containment.
• Provide information relating to claims process and procedure.
• Specify and report on manual bill review and later automated bill reviewed cases.
• Support in the identification, development and implementation of cost-effective processes in order to increase efficiency and reduce cost drivers related to the area of specialization.

Provide Input into Treatment Protocols

• Participate in the development of basket of care and its alternatives for each individual treatment plans/ protocols.
• Provide inputs to development of treatment plans/ protocols and crosswalks.
• Identify relevant treatment plans and gaps in bill review and provide the feedback to Senior Medical Manager to update treatment protocols.

Policy Review and Implementation

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

Reporting

• Prepare and submit regulation reports as and when required to provide progress updates and/or inform management decisions.
• Develop reports/ 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.

Provide Support to Bill Reviewers

• Provide bill review clinical and technical support.
• In collaboration with L&D, ensure updated and standardised training of Bill Reviewers.
• Support the bill review team in complicated queries.
• Manage and create productivity management tool for bill reviewers.
• Develop quality management tool /sampling tool to monitor work of bill reviewers. 

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.

Qualifications and Experience

• Bachelor’s Degree/ Advanced Diploma in Nursing related qualification.
• Valid Registration with the SANC as a Registered Nurse.
• Qualification in Critical care/ Emergency care/ Theatre technique will be advantageous.
• Relevant 5 - 7 years’ experience in an ICU Unit/ High Care/ Emergency Unit of a multidisciplinary hospital or Medical Scheme environment.
• With experience in working with ICD 10 codes, CPT codes, NAPPI codes, tariffs, and all modalities of treatment in ICU, theatre, and ward. 

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Key Performance Areas

Enterprise Architecture

• Facilitate establishment of Architecture Standards and Policy.
• Institute Enterprise Architecture Governance.
• Lead or provide guidance on Business Solutions Development.
• Ensure that the application or systems, data and technology aspects of the enterprise architecture are driven by the business imperatives of the organisation and that the requirements driving the overall architecture are managed consistently and effectively.
• Understanding and presenting the immediate/tactical and strategic benefits of adopting a consistent architectural approach within the context of the client’s business to help the client justify his investments.
• Ensure architectural recommendations that are in line with the strategic vision for the enterprise and wider best practice.

Documentation

• Determine Enterprise Architecture policy and standards definition and evolution and works with PMO to coordinate project pipeline management.
• Ensure governance by defining and establishing processes by which software and operating models are built.
• Ensure enterprise architecture review are done periodically to evaluate and address technology standards adherence.
• Design and present Architecture concepts to various high level committee structures.
• Author Enterprise Architecture documents for specific projects or programs clearly articulating goals, constraints, and rationale for all architecturally significant decisions. Lead scoping and design sessions across cross-functional teams. Lead the process of determining technical infrastructure design. Consult with different groups to analyze and understand and achieve functional requirements, objectives, desired features, and overall user experience. Collaborate on technical reviews of applications to assess the quality of their solution.
• Perform application portfolio rationalization. Analyze, define, and document system architecture and design for data, workflow, security, hardware integration, operating system environment, interfaces with other systems, internal and external checks and controls, and outputs. Identify key components and requirements necessary to ensure that architecture of the integrated environment is capable of reaching maximum levels of availability, efficiency, scalability and security.

Policy Review and Implementation

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

Stakeholder Management

• Act as a champion to help all facets of the development enterprise (hardware, software, integration) to understand and adopt these standards and policies. Collaborate in Enterprise Architecture planning initiatives to arrive at:
• Current state architecture.
• Client state architecture.
• Roadmap.
• Risks & constraints.
• EA policy and standard definition.
• Engage relevant peers from other disciplines or domains during implementation of Solution Architecture/Design.
• Engage relevant peers from other disciplines or domains during implementation of Solution Architecture or Design.
• Evangelize and syndicate high-level Enterprise Architect strategy across the enterprise and to the Company’s key stakeholders.
• Provide direction and management to ensure that enhancements and modifications to the system adhere to all System and Business Development Methodology and Quality of Service Standards in order to deliver a quality enhancement that meets business requirements.

Reporting 

• Prepare and submit regulation 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.

Qualifications and Experience

• Bachelor’s Degree/ Advanced Diploma in Information Technology/ BSC Computer Science related qualification.
• TOGAF certification.
• ITIL certified will be an added advantage.
• Certification in Business Process will be an added advantage.
• Certification in Systems and Business Architecture will be an added advantage.
• Professional Project Management certificate will be an added advantage.
• Relevant 5 - 7 years’ experience in an ICT Enterprise/ Solution Architect environment.

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Key Performance Areas

Provision of Legal Advice to Business

• Manage, monitor and report on legal advice provided by the Legal Advice section.
• Instruct attorney to brief counsel on legal opinions.
• Where appropriate consult with attorney and counsel.
• Conduct legal research.
• Draft and communicate legal opinion/advice.
• Collaborate with the Training Department on specific training requirements and the development of training material;
• Publish a monthly Legal Advice Newsletter;
• Publish periodically legal articles in external media; and
• Maintain and update legal advice register.

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.

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 in Law or equivalent
• Postgraduate in Law related qualification will be an added advantage.
• Admission as an Attorney of the High Court or Advocate.
• Right of appearance in the High Court will be an added advantage.
• Relevant 6 - 8 years’ experience in a Legal environment of which 2 years must have been on manager/ supervisory level/ area of expertise.

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Key Performance Areas

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.

Preparation and research on related litigation matters

• Conduct research that will provide information in preparation for all matters for trial.
• Consult with client departments/representatives, and witnesses for instructions and documentation for cases to be presented in court.
• Draft pleadings to provide clear motivation/justification on a particular position about the case.

Mediation process

• All required steps regarding the mediation process, as governed by the amendment to the rules of court, are to be taken.
• Upon conclusion of the mediation, parties shall inform the Registrar and all other parties by a notice that Mediation is completed.
• Parties & Mediator must within 5 days of completion of mediation issue a joint minute indicating.

Represent the Road Accident Fund on all third party claims and related litigation matters

• Attend court appearances in all allocated third-party litigation matters.
• Ensure file administration from opening to the conclusion of a legal case including adherence to trial dates.
• Handle appearances at courts, tribunals, mediation hearings and inquiries.
• Approve instructions to appoint and instruct expert witnesses.

Settle non-litigious matters before they are set down for trial

• Block consultation, early assessment of files, and early instructions to experts and assessors.
• Approve requests to appoint and instruct assessors and expert witnesses.
• Recommend a settlement.

Provision of legal advice to RAF

• Provide legal advice on arising legal matters and contracts.
• Provide well-researched legal advice on matters impacting the organisation.
• Conduct legal research and prepare legal opinions.

Taxation

• Deliver a full range of tax services in compliance with laws and regulations.
• Build relationships and interact with clients to provide consulting and expertise in tax services.
• Provide innovative tax planning and review complex income tax returns.

Reporting

• Prepare and submit regulation 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.
• Prepare proposals, briefings, presentations, reports and other documentation and provide management with information both verbally and in a report format.

Stakeholder Management

• Facilitate and manage communication with relevant internal and external stakeholders in relation to invetments 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.
• Communication with all levels of stakeholder contact.

People Management

• Ensure the sourcing, development and retention of a high-performance team.
• Manage the recruitment of the operational workforce in line with employment equity targets.
• 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 in Law or equivalent.
• Post-graduate in Law or equivalent.
• Admission as an Attorney of the High Court or Advocate.
• Right of Appearance in the High Court.
• Relevant 5-7 years Legal Experience Post-graduation or Admission of which 2 years must have been on area of expertise (Personal Injury Litigation).

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Key Perfromance Areas

Pre-Assessment of Prospective Claims

• Record all the submitted documents for prospective claims. 
• Determine the benefits and the products submitted based on the submitted documents. 
• Assess the submitted documents to determine compliance as per defined processes and rules. 
• Apply compliance and/lodgement rules in the pre-assessing the prospective claim. 
• Identify duplicate claims and linked claims. 
• Examine the prescription of lodgement and apply prescription rules. 
• verify mortality with Home Affairs. 
• Communicate the assessment outcomes to the prospective claimants. 

Quality Assurance

• Ensure that pre-assessment processes are implemented and maintained at the highest standards. 
• Maintain the implementation an unusual occurrence procedures. 

Administrative Support

• Document the acknowledged claims. 
• 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 adhoc reports on process improvement initiatives. 

Stakeholder Management

• Maintain healthy relationships with all stakeholders. 
• Follow up and feedback to all stakeholders to keep them updated on the status of a query. 
• Respond to queries within the predefined turnaround times. 

Qualifiction and Experience

• Bachelor's Degree / Advanced Diploma in a related qualifiction. 
• Relevant 3 years experience in the Claims environment. 

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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 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 assure the outcomes liability determination and capture the reasons for disagreement.
• Ensure that merits processes are implemented and maintained at the highest standards.
• Maintain the implementation an unusual occurrence procedures.

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 and Experience 

• Bachelor’s Degree / Advanced Diploma in a Health sciences or Law related qualification.
• Relevant 3 years’ experience in an insurance/ investigations/Claims related environment.

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Key Performance Areas

Outsourced Investigations

• Conduct preliminary investigations into allegations of fraud, waste or abuse committed by customers against RAF or by internal RAF staff members.
• Manage deliverables for outsourced investigations.
• Participate in the evaluation and selection process of service providers.
• Design and drive consistent and organised processes for outsourcing investigations.
• Monitor and communicate costs, project status, risks and key learnings on outsourced investigations.
• Closely work with the different cross functional support departments to develop and strengthen the execution of the outsourcing strategy.
• Ensure service providers are delivering according to contract milestones and quality standards.
• Maintain tracking systems to monitor contract status and for business continuity.

Reporting

• Contribute to the preparation and submission of regulation reports.
• Aid in the development of functional reporting systems, for management, project or performance reporting.
• Report regularly and periodically perform necessary submissions as and when required to provide progress updates and/or inform management decisions.

Stakeholder Management

• Aid in proactive and progressive relationships with key stakeholders.
• Deal with inquiries and requests for information from both internal and external stakeholders.
• Aid in the maintenance of relationships with vendors, service providers or procurement teams and ensure that all relevant procured items are invoiced and paid on time.

Qualifications and Experience

• Bachelor's Degree/ Advanced Diploma in Commerce (Bcom Accounting/ Internal Audit/ Financial Management/ Risk Management/ BCom Law/ Forensic Accounting/ Economics and Information Systems)/ Forensics or LLB.
• Valid code EB driver’s license.
• Relevant 4 years’ experience in Fraud Investigations.
• 1 year experience must be in project management or management of outsourced investigations will be an added advantage.