Job Vacancies at Road Accident Fund

Key Performance Areas

Medical management.

• Conduct medical assessment and compile injury assessment reports.
• Conduct assessments and bill reviews on submitted claims, focusing on the appropriate level of care, the length of stay, and quality of care.
• Incorporate tariffs, 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 and / or any that is considered reasonable.
• Preauthorize submitted claims aligned to RAF clinical guidelines including the RAF formularory, treatment protocols and related tariffs.
• Escalation of complex cases for multi-disciplinary review and adjudication.
• Participate in the consultations process on the implementation of medical claims processes.

Exception handling

• Ensure the implementation and maintenance of a formal exception handling process within the medical management.
• Maintain the documentation and regular updating of the exception handling process.
• Maintain the implementation of an unusual occurrence procedure.

Reporting.

• Track and report against set objectives and targets.
• Report on emerging risks.
• Provide ad hoc reports on process improvement initiatives.
• Produce documents, briefing papers, reports and presentations.

Stakeholder management.

• Deal with/and respond to correspondence.
• 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 and Experience

• Bachelor’s Degree/Advanced Diploma in Health Sciences /Medical related qualification.
• Registration with HPCSA/SANCA.
• Relevant 3 years’ experience in a Medical related environment.

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Key Performance Areas 

General management and support to Attorney

• Provide research assistance to attorneys.
• Assisting with searching and checking public records on behalf of attorneys.
• Assisting with the interviewing of clients, and witnesses.
• Assisting with collecting, retrieving, and analysing information relevant to litigation cases.
• Assisting attorneys with trial and its preparation.
• Analysing and conducting research for reporting purposes.

Document management

• Assisting with the preparation of legal documents and arguments.
• Summarising depositions and other documents.
• Preparing briefs and pleadings and drafting discovery documents.
• Managing and organising cases.
• Updating file registers

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

• Bachelors Degree in Law or equivalent. 
• Relevant 3 years’ experience in a legal environment.

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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 is 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 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 check 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 assessments associated 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.