The Road Accident Fund is a state insurer established by statute, it provides insurance cover to all drivers of motor vehicles in South Africa in respect of liability incurred or damage caused as a result of a traffic collision. Liability incurred in relation to property damage (such as damage to vehicles, buildings, vehicle contents) is excluded from cov...
Key Performance Areas
Investigation and assessment of Claims lodged
- Trace insured driver / witnesses to consult and obtain statements and docket.
- Ensure that a proper sketch plan of an accident scene is drawn as part of the investigation and assessment process.
- Ensure that clear photographs of an accident scene, faces of the people interviewed, damaged vehicles and injuries to a person are taken as part of the investigation and assessment process.
- Obtain and / verify existing affidavits from different parties (e.g. claimants, witnesses, employers, etc.).
- Identify possible fraud and corruption and escalate to the Forensic Investigation Department (FID).
- Testify in court cases when a claimant is guilty and accused of fraud.
- Provide assistance in ensuring witness presence at court.
Administrative support
- Validate supporting documents (e.g. employment details, paternity/ maternity details, SARS documents, etc.) for all related quantum investigations.
- Verify details of the claimant and those injured in an accident through Natis and Cross Check systems (e.g. ID no, contact numbers, address/s, employment details, etc.)
- Verify the details of the secondary vehicle/s involved in the accident to determine the owner/s.
- Quality checks the supporting documents from stakeholders to determine the validity of the logged claim.
- Validate loss of earnings.
- Provide progress reports as per the internal service level agreement.
Document and records Management
- Monitor and maintain an effective filing system.
- Ensure that files are correctly categorised and stored to ensure a smooth retrieval of documents.
- Administer the records management and filling processes in line with the RAF filling plan.
- Ensure confidentiality of all documents under control and that correspondence from the department office reaches intended recipients.
- Perform File Retrieval in Archive Services.
Stakeholder Management
- Provide advice to different parties (e.g. claimants, witnesses, employers, etc.).
- Handle any assessment associated with complaints.
- Maintain relationships with internal and external stakeholders.
Qualifications
- NQF 7 (bachelor's degree or Advanced Diploma) related qualification to discipline.
- Driver’s License.
- Completed training as an investigator will be an added advantage.
- Being a certified fraud examiner will be an added advantage.
Experience
- Relevant 3 years’ experience in a similar environment.
- Experience in merit and quantum investigations will be an added advantage.
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Key Performance Areas
Messenger services
- Collect correspondence from respective government institution, verify against the list before collection and acknowledge the receipt.
- Deliver packages or messages on time.
- Handle packages and documents with care.
- Drive delivery truck to the destination.
- Reconcile packages at recipient’s location.
- Maintain communication with destination and point of departure.
- Obtain receipts or signatures for deliveries and documentation.
- Maintain records of daily visits in the logbook.
- Sort deliverable items in accordance to delivery route in order to ensure maximum efficiency.
- Confirm deliveries by checking into the office after each delivery.
- Deliver the documents to Document Services for them to distribute in line with the SOP.
- Plan efficient routes prior to setting out on a delivery mission
Administration
- Monitor and make sure that requests for copying or binding are executed efficiently and timeously.
- Monitor the availability of messenger services for delivery of items to financial institutions, Government departments, clients, etc. at all times.
- Ensure that archiving of scanned files and documents is done in accordance with the National Archives Act as well the RAF’s RM strategies and objectives.
- Sort documents according to documents class and insert.
- Forward the transfer (Metro-file) and requests for inactive records to the Records Manager.
- Prepare and capture records to be transferred to the offsite storage, forward to Records Management and maintain a log of records sent off-site storage.
- Receive records file index spread sheet and keep track of all the updates for records stored off-site.
- Maintain an inventory of the department’s records, showing each record series title, file plan reference number, and retention period as listed on the Records Retention Schedule (RRS).
- Complete the final disposition log/ register that have been destroyed.
- Monitor that the postal service facility in the branch is operating effectively at all times.
- Efficient and timely document binding service.
Transportation and Operation
- Load and unload organization’s merchandize.
- Transport products, materials, and staff securely to areas where they are needed.
- Recognize electrical and mechanical faults and report to Facilities Manager.
Vehicle, Machinery & Equipment Maintenance
- Perform daily pre trip and post trip vehicle inspection to ensure safety standards are adhered to.
- Ensure that the copying and binding machines are maintained in working order
Reporting
- Report vehicle, machinery and equipment defects, accidents, traffic violations, damage to the vehicles or loss of equipment.
- Ensure vehicle is always in good condition.
- Provide logbooks in line with the Fleet Management Policy.
- Reporting of unexpected delays.
- Report on the maintenance of the franking machine in terms of technical maintenance and the loading of money.
- Report on major equipment faults requiring service provider attention immediately to supervisor.
Process incoming / outgoing mail and mail batching
- Receive, register and stamp incoming and outgoing correspondence.
- Separate incoming documents and faxes and sort according to destination.
- Ensure files, correspondence and all other documentation is filed according to established policy and procedure.
- Prepare outgoing mail for posting bulk mailing and bulk distributions.
- Record details of all registered mail and Docex Tracker mail.
- Declare monies received and capture in register.
- Prepare Check addresses and ensure Docex is sent to Docex, Normal and Registered mail to the Post Office
Qualifications
- Matric or Grade 12 certificate
- A valid code 10 (EC1/EC) driver’s license.
- Professional Driver’s Permit.
Experience
- At least 1 year’ experience in a driving/messenger services environment.
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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 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 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.
- Coordinate administrative legal actions to ensure compliance.
- 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 information both verbally and in report format.
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 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
- Bachelor’s Degree in Law or equivalent.
- Postgraduate in Law or equivalent.
- Admission as an Attorney of the High Court or Advocate.
- Right of appearance in the High Court.
Experience
- Relevant 5-7 years legal experience post-graduation or admission of which 2 years must have been in area of expertise (personal injury litigation)
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Key Performance Areas
Policy review and implementation.
- Provide input into the enhancement and implementation of the case management policies and strategy and plan to ensure an alignment with short term and long-term objectives
- Manage the implementation of the case management strategy approved, including as appropriate any special tasks or projects requested by management
Clinical care management
- Manage the clinical status of claimants in accordance with the prescribed requirements throughout the case management process
- Manage the provision of clinical assessments to ensure that admissions adhere to approved criteria
- Ensure an accurate, appropriate, and complete diagnostic and procedural coding of all claimants’ records
- Manage the assessment of medical problems of the injured and the provision of quality of care
- Identify training needs of the Senior Officers: Hospital Case Management in line with the scope of work and the changes in the processes.
Manage the provision of patient care
- Substantiate claimant hospitalization in terms of treatment, length of stay and level of care
- Ensure that a comprehensive assessment for claimants is performed and that a follow-up in accordance with the schedule determined/ agreed is undertaken.
- Ensure the monitoring of claimant treatment recovery progress to recommend adjustments where necessary
- Ensure that the claimants focused plan of care is coordinated and communicated to ensure attention is being focused on progression towards discharge.
- Ensure that the quality of health care provided to claimant is monitored to ensure they are up to acceptable standards.
- Manage and ensure that the discharge plan for the claimant is effective and allows for continued treatment after hospital discharge
- Ensure that claimants have the necessary utilities and amenities required for complete recovery
- Provide alternative treatment options to ensure a cost effective and efficient plan of care
- Manage and fast track case management reports and recommendations relating to the issuing of Undertaking Certificate and Interim Undertaking Certificates.
- Analyze and approve the recommendations for the transfer of claimants to better facilities of care
Case management and administration
- Manage all assigned cases
- Manage the development of practice and/or clinical guidelines for cost effective care
- Intervene on clinical discussion relating to the care of MVA claimants as per the SLA and MOU
- Present cases at case rounds/ conferences to obtain multidisciplinary perspective and recommendations to achieve optimal outcomes
- Manage the provision of claimants care plan and compliance reporting
- Manage claimants case management plans, authorizations, assessment, and levels of care
- Manage the review of medical records to identify specific medical issues
- Identify financial and business risks to the Fund and escalate accordingly
- Analyze claimants care reports and make recommendation in preparation of the rehabilitation handover post discharge
- Manage high cost hospital cases and establish a forum for case managers to present high cost cases
Manage the submission of invoices
- Validate and quality assure invoices submitted to ensure that they are aligned to the services and treatments claimed for
- Ensure financial and case management documentation supports accurate record-keeping and future requirements
- Put measures in place to safeguard against the submission of fraudulent invoices
- Manage the compliance of invoiced services from service providers and ensure validity in line with RAF Act and guidelines
- Manage timeous payment of healthcare professionals for service rendered
Reporting
- Prepare and submit monthly and quarterly performance reports or as and when required to provide progress updates and/or inform management decisions
- Develop functional reporting systems for case management, projects or performance reporting
- Prepare proposals, briefings, presentations, reports, and other documentation and provide management information both verbally and in report format.
Stakeholder management
- Engage in hospital visits where needed to build stakeholder relationships, proactively resolve queries and increase visibility to claimants
- Build productive relationship with healthcare professionals to ensure adequate referral rates to achieve budgeted occupancy level
- Build professional, long-term relationships with Funders and other stakeholders
- Ensure accurate service knowledge and advice and keep stakeholders informed of products and service options
- Manage the resolution of stakeholder queries and complaints promptly.
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 / Advanced Diploma in a Health sciences or Medical related Degree..
- Postgraduate in Health Sciences or Medical related qualification will be an added advantage
- Registration with the relevant Health professional body
- Relevant 6-8 years’ experience in Nursing or Case Management environment of which 2 years must have been on a management/supervisory level/area of expertise
- ICU/Theatre or High cost Case Management experience will be an advantage.
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Key Performance Areas
Telecommunications
- Must be able to speak clearly
- Excellence in speaking English
- Operate switchboard systems
Integrity
- Must be honest
- Self-control
Customer and personal Services
- Must be able to explain what the purpose of the RAF is.
- Must be able to advise customers on process and procedures in place.
- Must be able to explain the information required to lodge a claim.
Reporting
- Must be able to explain what the purpose of the RAF is.
- Must be able to advise customers on process and procedures in place.
- Must be able to explain the information required to lodge a claim.
Qualifications
- NQF 4 (Matric or Grade 12) qualification.
Experience
- Relevant 1 years’ experience in a similar environment.
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Key Performance Areas
Funeral adjudication
- Review the claim against the funeral adjudication standards.
- Apply funeral benefit adjudication rules to determine quantum.
- Generate funeral product offer using relevant offer template.
- Obtain approval in line with DOA.
- Research, analyse, and review policies and laws relevant to assigned cases.
- After approval, communicate the offer to the claimant through offer management.
Quality assurance
- Participate in the consultations process on the implementation of claims and related processes.
- Ensure that claims and processes are implemented and maintained to the highest standards.
- Maintain the implementation an unusual occurrence procedures.
- Quality assure the funeral adjudication claims before they can be progressed to the next phase of the claims processing.
Administrative support
- 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 feedback to all stakeholders to keep them updated on the status of a query.
- Respond to queries within the predefined turnaround times.
Qualifications
- Bachelor’s Degree/Advanced Diploma in a related qualification.
Experience
- Relevant 3 years’ experience in a claims adjudication related environment.
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Key Performance Areas
Loss of earning adjudication
- Confirm and record medical management recommendations.
- Review the claim against the loss of earnings adjudication standards.
- Check injury documents substantiating an ability to earn an income and make a determination.
- Analyze the age, qualification level and skillset of the claimant to determine whether the applicant qualifies for an LOE.
- Make a determination on whether the injured is able to earn an income or not as well as whether the injured is major or minor.
- Apply applicable case laws and Statutory limit to determine the LOE quantum.
- Schedule the injured for medical assessment in line with the findings.
- Make recommendations on an appropriate amount of money for payout per case.
Quality assurance
- Adjudicate the LOE product claim in line with the approved policy/SOP.
- Participate in the consultations process on the implementation of programs and services.
- Ensure that programs and services are implemented and maintained to the highest standards.
- Implement the development and implementation of unusual occurrence procedures.
- Quality assure the loss of earning claims before they can be progressed to the next phase of the claims processing.
Administrative support
- Record and document proof of affinity.
- 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.
- Respond to queries within the predefined turnaround times.
Qualifications
- Bachelor’s Degree/Advanced Diploma in a related qualification.
Experience
- Relevant 3 years’ experience in a claims adjudication related environment.
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Key Performance Areas
Verification and Validation.
- Apply sound legal (RAF Act and Regulations to Act, Case Law) knowledge on a daily basis to validate claims.
- Search for and apply relevant Case Law during verification and validation.
- Determine the need to call in the injured for questioning in line with the RAF act.
- Apply RAF procedures to validate the claims.
- Assess duplicate claims to address mandates and minimise further processing of duplicate claims.
- Examine and apply the prescription of rules at the claim and product level.
- Verify data and information with relevant stakeholders.
- Assess the validity of death benefits products to determine locus standi.
Quality assurance
- Maintain and update necessary reporting standards as per standard operating procedure.
- Adequate and sound quality assurance.
- Ensure that verification and validation are maintained at the highest standards.
- Maintain the implementation of an unusual occurrence procedure.
Administrative support
- Document the acknowledge pre assessed 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.
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.
Reporting
- Track and report against set objectives and targets.
- Report on emerging risks.
- Provide ad hoc reports on process improvement initiatives.
Qualifications
- Bachelor’s Degree/Advanced Diploma in a related qualification.
Experience
- Relevant 3 years’ experience in the Claims environment.
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Key Performance 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/ lodgment rules in pre-accessing the prospective claim.
- Identify duplicate claims and linked claims.
- Examine the prescription of lodgment 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 ad hoc 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.
Qualifications
- Bachelor’s Degree/Advanced Diploma in a related qualification.
Experience
- Relevant 3 years’ experience in the Claims environment.
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Key Performance Areas
Settlement and payments of Legal costs
- Acknowledge receipt of hard copy files from Legal Cost Assistant
- Prioritise files on the basis of taxation and fee analysis
- Evaluate bills of costs settled or taxed
- Assess bills of costs not set down for taxation
- Assess bills of costs set down for taxation
- Assess bills of costs for block settlements
- Mark bills and make settlement offers
- Attend taxation at court
- Process bills for payment on acceptance of offer or consider counter proposal if offer is rejected
- Prepare for and attend court for taxation
- Instruct Pane Attorney or Cost Consultant in consultation with supervisor to attend taxation
- Approve bills in terms of delegation of authority
- Attend to queries from both internal and external stakeholders
- Review matters as taxed /settled and attend to such review and attend court appeal
- Provide advice to claims sections, attorneys and costs consultants
- Approve legal cost payments in terms of delegation of authority
- Maintain accurate record of activities for submission to supervisor
Writs:
- Assess the file and check the validity of the writ
- Collate all the required documents
- Calculate interest amount
- Check if the correct sheriff is being paid
- Total amount due is payable
- Confirm it is not a duplicate payment
- Assess the writ causes
- Advise the management on the exact cause
- Recover the extra costs where applicable.
Qualifications
- NQF 7 (bachelor's degree/Advanced Diploma) in Law or a related qualification to discipline.
Experience
- Relevant 3 years’ experience in a claims environment.
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Key Performance Areas
Loss of support adjudication
- Review the claim against the loss of support adjudication standards.
- Assess loss of support supporting documents and data to determine the deceased duty to support (confirming affinity).
- Determine deceased ability to support the defendants by assessing income supporting data/documents in line with the approved quantum.
- Apply applicable case laws and Statutory limit to determine the LOE quantum.
- Based on the findings, make a determination to reject or approve.
- Assess actuarial reports and make a determination to whether to instruct internal actuarial team to make actuarial calculation or not.
- Make an offer and submit to offer management for further communication with the claimant.
Quality assurance
- Research, analyse, and review policies and laws relevant to assigned cases.
- Participate in the consultations process on the implementation of claims and related processes.
- Ensure that LOS Adjudication and processes are implemented and maintained at the highest standards.
- Maintain the implementation an unusual occurrence procedures.
Administrative support
- 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.
- Respond to queries within the predefined turnaround times.
Qualifications
- Bachelor’s Degree/Advanced Diploma in a related qualification to discipline.
Experience
- Relevant 3 years’ experience in a claims adjudication related environment.
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Key Performance Areas
Perform assessment of bills
- Screening and checking compliance with the RAF Act, Rules of Court, SLA and Applicable RAF Tariffs.
- Evaluation of bills of cost that are settled and or taxed.
- Assessment of Bills of Cost set down for taxation and those that are not set down.
- Assessment of Bills of Cost for block settlements.
- Prepare and make cost contributions and settle Bills of Cost.
- Evaluate assessor invoices and accounts in terms of the SLA and applicable tariff.
- Conduct research on case law and legal principles to keep abreast of developments.
- Preparation of executive summaries for legal costs as per threshold.
Assessment of Service Provider’s Bills and Invoices (Panel Attorneys)
- Evaluate and tax Advocate’s accounts in terms of SLA and applicable tariff.
- Evaluate Panel Attorney’s files in terms of RAF tariff.
- Evaluate assessor invoices and accounts in terms of the SLA and applicable tariff.
- Assessment of disbursement of Experts Accounts.
- Referral of SLA breaches to panel management.
- Attend to block bookings.
Attend to Taxation of Bills of Cost
- Prepare and make offers and settle Bills of Cost
- Attendance at Magistrate’s Court and Regional Court for taxations.
- Attendance at High Courts for taxations.
- Appearance before the taxing Master to argue complex legal principles governing taxations of legal costs.
Attend Reviews of Bills of Cost
- Appearance before the taxing Master and the Magistrate to argue complex legal principles governing taxations of legal costs.
- Prepare review documents for review proceedings in court
- Serve review documents to opposing parties citing the basis of review.
- Attend court and appear to argue the basis of review in front of Magistrate or Judge.
Attend to Litigation relating to costs.
- Negotiate reasonable settlements of costs.
- Request cost payment
- Recover extra costs where applicable and advise Management accordingly.
- Instruct panel attorneys to oppose and settle costs and costs applications.
- Provide advice to Legal department in respect of Litigation processes received.
- Updating the status of claims view note.
- Perform verification to ensure that the right payment is made to the correct Attorney.
Authorization of Bills of Cost for payment
- Attend to Fee analysis.
- Perform duplicate checks.
- Evaluation of bills of cost that is settled and or taxed.
- Process Bills of Cost that are settled and or taxed.
- Approve Bills of Cost that are settled and or taxed in terms of delegation of authority policy.
- Request payment on the system.
- Prepare the source documents to be forwarded to Finance department for checking and payment.
- Keep daily statistics of activities and trends on work allocated and work to be assessed.
- Submit daily and monthly statistics as required by Management.
- Keep record of statistics for performance management and review.
- Attend queries from stakeholders pertaining to Bills of cost settled and outstanding payments of accounts.
- Referral of writs reports to quality assurance.
- Prepare batch report for payment department.
Play advisory role and function to Claims Departments, Attorneys and Cost Consultants.
- Prepare and render advice to claims sections, attorneys and cost consultants
- Instruct Panel Attorneys to attend taxations on behalf of RAF in respect of courts not falling within the proximity of offices of RAF.
- Conduct research on Case Law and legal principles to keep abreast of developments.
Quality assurance on writs reporting.
- Investigation, reconciliation of Writs and reporting.
Qualifications
- NQF 7 (bachelor’s degree or Advanced Diploma) in Law or related qualification.
- Admission as an Attorney would be advantageous.
Experience
- Relevant 3 years’ experience in Claims or Legal Costs 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 unit for further 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 assures the outcomes of liability determination and captures the reasons for disagreement.
- Ensure that merits processes are implemented and maintained to the highest standards.
- Maintain the implementation of an unusual occurrence procedure.
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
- Bachelor’s Degree/ Advanced Diploma in a Health Sciences or Law related qualification.
Experience
- Relevant 3 years’ experience in an insurance/ investigations/ claims related environment.
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Key Performance Areas
Management of claims payment process.
- Verify and approve payments in line with DOA by confirming the accuracy, validity, completeness and existence of a payment by inspecting supporting documentation to confirm the following:
- Payee to the trigger and supporting documents (per above)
- Banking details for both the trigger document and any supporting documents
- Amounts through verification of supporting documents
- Payment is not a duplicate by ensuring the financial enquiry reports are attached to the EA as supporting documents of payment
- Elimination of duplicate payments through implementation of effective internal controls
- Attend to and resolve queries timeously
- Maintain and develop good relations with claimants, attorneys, firms and colleagues
Financial Management
- implementation of and adherence to financial management principles to ensure valid, accurate and complete processing of Claims payments
- Appropriate implementation of and adherence to applicable Policies and procedures
- Interrogate supporting payment documents for accuracy, validity and completeness
- Continuous improvement in internal controls in relation to claims Payment Approval process
- Check completeness and accuracy of batch reports
Reporting
- Contribute to Weekly reporting on Flash Stats
- Daily reporting on queries that could not be resolved
- Daily reporting of non-compliance
- Daily reporting on stakeholder queries
- Attend and contribute to Monthly staff meetings in the regions
- Produce monthly reports for claims management
Monitoring and Evaluation.
- Adhere to the effectiveness in terms of service delivery of claims payment function
- Report on non-compliance with the RAF claims payments, processes and procedures
- Deal with queries and ensure that they are resolved timeously
General Administration
- Identify training and development needs for self
- Compliance with company policies and procedures
- Assist in inducting new employees into the division
- Ensure that all administrative functions related to the role is executed
Qualifications
- NQF 7 (bachelor's degree or Advanced Diploma) in Commerce/Financial Accounting/Accounting related qualification
Experience
- Relevant 3 years’ experience in a financial environment
Method of Application
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