Latest Jobs at Road Accident Fund

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 settlements 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 Officer
• 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 the 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 monthly basis.

Qualifications and Experience

•  NQF 7(bachelor’s degree OR Advanced Diploma) related qualification to discipline.
• Relevant 3 years’ experience in the claim’s environment.

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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 settlements 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 Officer
• 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 the 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 monthly basis.

Qualifications and Experience

•  NQF 7(bachelor’s degree OR Advanced Diploma) related qualification to discipline.
• Relevant 3 years’ experience in the claim’s environment.

go to method of application »

Key Performance Areas

Claims Handling

• Ensure the correctness of the interpretation of the settlement, the undertaking, any limitations and or the past medical expenses to determine the Funds liability for future costs to be incurred.
• Ensure that any discrepancies are corrected by the re drafting of the undertaking to reflect the correct liability.
• Ensure that cognisance is taken of all expert reports, of internal and external origin, as well as the Medical and Legal assessment to determine the Funds liability for the costs incurred.
• 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.
• Ensure that matters are referred to field Case Managers for further investigation.
• Ensure that the need for home visits are timeously identified and attended to when required.
• Ensure that the appropriate experts are appointed to do further assessments.
• Ensure the accurate quantification of undertakings.

Perform undertakings information audit

• Ensure the update in any change in the settlement details on the undertaking system to ensure that the liability of the Fund is accurately reflected on the system.

Qualifications

• NQF 7 (bachelor’s degree or Advanced Diploma) related qualification to discipline.

Experience

• Relevant 3 years’ experience in the claim’s environment.

go to method of application »

Key Performance Areas

Compliance administration.

• Maintain up-to-date written documentation relating to the department’s business activities.
• Ensure compliance with the policies and process standards.
• Keep abreast of internal standards and business goals to ensure adherence to sound internal control.

Office coordination.

• Aid in the maintenance of correspondence, filing, telephonic queries and providing general administration support to the office.
• Maintain strict confidentiality in all matters relating to the office.
• Assist in making follow-ups on outstanding matters.
• Ensure all requests are handled and responded to within set timelines.
• Engage and follow up with Processing Centers on outstanding matters.
• Assist in ensuring the availability of stationery within the department.
• Validate and verify information and documents submitted for accurate capturing and further handling.
• Ensure the systems/registers used are kept up to date.
• Check for duplicate documents, requests and queries and report on them.
• Allocate reference numbers and accurately capture related documents on different systems.
• Allocation of matters to responsible team members.
• Draft and send out letters to all stakeholders as required.

Meeting support

• Aid in arranging meetings on behalf of the department.
• Assist with taking and distributing minutes in accordance to set governance standards.
• Create and maintain a register to track matters outstanding.
• Support in the maintenance of follow-up plan on meeting resolutions and matters outstanding.
• Ensure confirmation of meetings and management of team diaries.
• Schedule appointments with internal and external stakeholders as and when required.

Document and Records Management.

• Administer the records management and filling processes in line with the RAF filling plan.
• Ensure that the filing system is always up-to-date and functional.
• Aid in the retrieval of information at all times as requested in the office.
• Ensure confidentiality of all documents under control and that documentation reaches the intended recipients.
• Acknowledge the receipt of documentation, apply a file number allocation, record data onto the computer system and file appropriately.

Qualifications

• Matric or Grade 12 certificate.

Experience

• Relevant 1 years’ experience in Administrative or similar environment.

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Key Performance Areas

Review of business requirements and system test

• Implement and maintain a testing strategy and testing process.
• Interpret test, specification test cases, and bugs defects.

Test planning

• Collaborate closely with application development team to plan for system testing.
• Test requirements gathering and analysis.
• Prepare test plan and get it approved.
• Test environment in association with the application development team.
• Document test results and get them approved.

Test case design and test execution

• Maintain Design clear, concise, and executable test cases based on the functional document, ensuring traceability to requirements, which includes positive, negative, boundary, and edge cases as follows:
• Identify what to test.
• Determine the prerequisites.
• Determine the test criteria.
• Record the expected test result.
• Ensure that testing procedures and practices align with data privacy regulations (e.g., POPIA) and internal security policies.
• Perform a shakeout on a built test environment.
• Perform the actual testing as per the testing process and methodology
• Identify, log, track, and manage defects using designated defect management tools.
• Conduct various testing types, including functional, regression, integration, usability, user acceptance testing (UAT) support, and basic performance/security testing.
• Participate in the design, execution, and maintenance of automated test scripts for solutions.

Reporting

• Provide clear and concise reports on testing activities and outcomes.
• Report regularly and periodically perform necessary submissions as and when required to provide progress updates and/or inform management of decisions.
• Compile reports on test coverage, execution results, and defects.

Stakeholder Management

• Provide timely feedback and support during sprints and deployments.
• Work closely with the applications development teams to resolve identified defects in a timely manner.
• Handle inquiries and requests for information from both internal and
• external stakeholders.
• Act as a key liaison between technical and business teams, facilitating effective communication regarding quality, defects, and testing progress.

Qualifications and Experience

• Bachelor’s Degree/Advanced Diploma in Information Technology related qualification.
• Relevant 4 years’ experience in IT and Application Testing environment.
• Experience with test automation frameworks (e.g., Selenium, Appium, Playwright, QTP/UFT) will be an added advantage.
• Experience in testing APIs and using tools like Postman or SoapUI will be an added advantage.
• Experience in testing Mobile and/or Power Platform apps 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 neccessary 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.
• Liason 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 preparation 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.

Qualifications

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

Experience

• Relevant 4 years' experience in the Medical environment.
• Experience in Managed Healthcare.
• Knowledge of ICD and CPT coding will be an advantage.
• Valid code 08 driving license.

go to method of application »

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 neccessary 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.
• Liason 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 preparation 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.

Qualifications

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

Experience

• Relevant 4 years' experience in the Medical environment.
• Experience in Managed Healthcare.
• Knowledge of ICD and CPT coding will be an advantage.
• Valid code 08 driving license.

go to method of application »

Key Performance Areas

Compliance Administration

• Administer applicable standards, processes and procedures
• Maintain version control on documentation related to the departments business activities.
• Ensure compliance to the policies and process standards.
• Keep abreast of internal standards and business goals to ensure adherence to sound internal control.

Office Coordination

• Maintain strict confidentiality in all matters relating to the office.
• Make follow-ups on outstanding matters and escalate where required.
• Ensure all office requests are handled and responded to within set timelines.
• Ensure availability of stationery within the department.
• Compile and distribute relevant statistics and reports as per predefined standard as required.
• Coordinate operational office activities to ensure efficiency and compliance on the provision of the core function of the respective department.

Meeting Support

• Provide support in setting up meetings.
• Take minutes and distribute these in accordance to set governance standards.
• Mantain follow-up plan on meeting resolutions and matters outstanding.
• Ensure confirmation of meetings and management of team diaries.
• Schedule appointments with internal and external stakeholders as and when required.

Financial and Procurement Processes Administration

• Compile and follow up on requisitions with any procurement processes until finalised.
• Maintain the stock register for the department.
• Ensure timeous payment of invoices.
• Provide administrative support to all the departmental activities related to the SCM processes.

Document Control 

• Ensure that the filing system is up-todate and functional.
• Manage the retrieval of information at all times as requested in the office.
• Ensure confidentiality of all documents under control and that documentation reaches the intended recipients.
• Acknowledge the receipt of documentation, apply a file number allocation, record data onto the computer system and file appropriately.
• Update and maintain assets register and inventory for the department.
• Maintain records of all files, correspondences and registers.

Qualifications

• National Diploma in Office Administration/Business Management/related or respective discipline quaification.

Experience

• Relevant 2 years’ experience in an administrative or similar environment.