Job Vacancies at Road Accident Fund

• NB: is a Three (3) years Fixed-Term Contract position

Purpose of the job: The Consultant: Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing.

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.
• Pre authorise submitted claims aligned to RAF clinical guidelines including the RAF formularory, treatment protocols and related tarrifs.
• 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 an unusual occurrence procedures.

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

• Bachelor’s Degree/Advanced Diploma in Health Sciences /Medical related qualification.
• Registration with HPCSA/SANCA.

Experience

• Relevant 3 years’ experience in a Medical related environment.
• Technical and behavioral competencies required
• Claims management process/ processes and systems.
• Medical product management
• Medical bill reviewing
• Medical case management
• Complex problem identification, solving and decision making
• Customer value proposition
• Strong clinical analytical capabilities
• Knowledge of motor vehicle accident legislation
• Planning, Organising and Coordinating
• Personal Mastery
• Judgement and Decision Making

Ethics and Values

• Client Service Orientation

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Purpose of the Job: Pre Assessment is responsible for the pre assessment of prospective claims applications.

• NB: This is a 18 Month Fixed Term Contract.

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 assessing 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 of an unusual occurrence procedure.

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 and Experience

• Bachelor’s Degree/Advanced Diploma in a related qualification.
• Relevant 3 years’ experience in the Claims environment.
• Behavioral competencies required.
• Planning, Organizing and Coordinating.
• Personal Mastery.
• Judgement and Decision Making.
• Ethics and Values.
• Client Service Orientation.
• Technical competencies required.
• Ability to differentiate different RAF Products.
• Knowledge of Motor vehicle Act.
• Complex problem identification, solving and decision making.
• Customer value proposition.
• Good financial management skills.
• Strong analytical capabilities.
• Knowledge of Motor Vehicle Accident legislation.
• PFMA knowledge.
• Attention to details.

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Job Description

Purpose of the Job: Reporting to the Senior Analyst: Corporate Actuarial Data Science, the Analyst: Corporate Actuarial Data Science is responsible for the analysis of financial risks within the Fund as well as to provide support in the management of financial risk.

Key Performance Areas

• Predictive analytics and modelling
• Participate in the development of predictive analytics solutions in order to improve fraud detection models and enhance customer experience.
• Assist team with developing, training, testing and deploying new predictive and analytical models using analytical models and algorithms.
• Gather and quality assure statistical data that is applied on predictive modelling and forecasting techniques.
• Assist with the development of scalable, efficient, and automated processes for large scale data analyses and model development, validation, and implementation.
• Maintain automated prescriptive analytics solutions that support various aspects of fraud monitoring and detection.
• Maintain existing data analytics solutions (code and/or models), to ensure that the data contributes to consistent improvements.
• Profiling data to be used to inform modelling approaches.
• Provide both technical and administrative support to the actuarial team, in producing statistical reports and analysis.

Actuarial analysis reporting

• Participate in the annual development of the Revenue Requirement Model (RRM) with various funding and/or operational scenarios which will be the basis of discussion with National Treasury regarding the funding requirements and for inclusion in the Strategic Plan and Annual Performance Plan.
• Support in the valuation assumptions performed by Actuaries and that the statutory actuary performs quarterly valuation on all claims.
• Perform an independent valuation on outstanding claims also on a monthly and quarterly basis.
• Perform quarterly valuation on outstanding claims.
• Perform the valuation on outstanding claims on a quarterly basis.
• Interpret acturial analysis correctly.
• Start the determination of costs, actuarial accrued liability and actuarial value of the assets for the Fund.
• Provide information and research on balance sheet management issues, like stochastic reserving, economic capital, asset liability management, and replicating portfolios.
• Contribute to the development of actuarial analysis “payout” models that will redesign compensation packages.
• Use Stochastic Modelling to determine distributions of potential future payments by the Fund.
• Draft the scope, liquidity/balance sheet reports.
• Support the design, implementation, review and audit of quantitative models for the calculation of Fund’s liabilities and capital requirements.
• Understand and use complex mathematical formulas, particularly in the area of advanced statistics and modelling.
• Produce easy to understand data visualizations and outputs.
• Make use of specialist software to complete data analytic tasks.

Reporting

• Aid in the maintenance of functional reporting systems, for management, project or performance reporting.
• Ensure regular and periodic reports are sent to the Senior Analyst for review and submitted as and when required to provide progress updates and/or inform management decisions.
• Maintenance and storage of proposals, briefings, presentations, reports, and other documentation and providing management information both verbally and in report format.

Stakeholder Management

• Assist with maintaining proactive and progressive relationships with key stakeholders.
• Assist 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.
• Assist with presentation of data findings in an easy-to-read and understood format.
• Continuous improvement and innovation
• Research industry best practice/innovations and identify where technology can be utilised in systems and processes.
• Understand job specific tasks and their requirements.
• Share ideas to improve the way of working.
• Contribute to creative sessions and offer ideas to the team.
• Participate in initiatives to improve service delivery.

Qualifications and Experience

• Bachelor’s Degree/Advanced Diploma in Actuarial Science/ Mathematics/ Investment Management/ Risk Management related qualification.
• Relevant 4 years’ experience in an actuarial data science related environment.
• Technical, Managerial, and behavioral competencies required
• Planning, Organising and Coordinating
• Personal Mastery
• Judgement and Decision Making

Ethics and Values

• Client Service Orientation
• External force and industry knowledge.
• Understanding of Modelling.
• Understanding of Actuarial valuations.
• Understanding of Actuarial reserving.
• Understanding of Data analysis/ actuarial analysis.
• Understanding of Actuarial investigations.
• Understanding of Statistical financial analysis.
• Understanding of Financial analysis.
• Knowledge of Forecasting and projections.

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Purpose of the Job: The Administrative Assistant: Verification and Validation Is to ensure a valid & legitimate claim is being filed.

18 months Fixed Term Contract

Key Performance Areas

• Movement of files and correspondence.
• Verification and Validation of claims.
• Record keeping.
• Stakeholder Relations.
• Interrogation.
• Office Administration.

Qualifications

• NQF 4 (Matric or Grade 12) qualification.

Experience

• Relevant 1 year working in an office environment.
• Competencies

Behavioural:

• Personal Mastery.
• Emotional Wisdom.
• Ethics and Governance.
• Customer orientation and Customer focus.

Technical:

• Computer literacy.
• Communication (Written, Verbal, listening).
• Customer service orientation.

Professionalism.

• Effective communication and negotiation skills.
• Good organisational skills.
• Analytical thinking and problem solving skills.