New Jobs at Road Accident Fund

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 at the highest standards.
• Maintain the implementation an unusual occurrence procedures
• Quality assure the funeral adjudication claims before they can be progressed to the phase of 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 initiative

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 a claims adjudication related environment.

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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, 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
• Preauthorise 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 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 and Experience       

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