Vacancies Available at Road Accident Fund

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

Verification and Validation.

• Apply sound legal RAF Act and Regulations to Act, Case Law) knowledge on 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 enviroment.

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Key Performance Areas 

Legal Secretarial Administration

• Prepare court statements and forms that Attorneys will need in court.
• Dictate Attorney’s audio files and written notes.
• Transcribe and proofread legal documents.
• Index and update pleadings and discovery binders.
• Collect and deliver documents.
• Supporting legal research for cases and communicating with vendors, experts, attorneys, opposing counsel and other staff.

Standard, Process and Procedure Maintenance

• Ensure a strategy framework is maintained by required standards
• Keep abreast of internal standards and business goals to ensure adherence to sound internal control.
• Provide administrative support to the strategy and reporting office by RAF policies and procedures

Quality Assurance Activities

• Maintain up-to-date written documentation and policies related to the organisation's business activities.

Office Management

• Mantain correspondence, filing, telephonic queries and provide general administration support to the office.
• Maintain strict confidentiality in all matters relating to the office
• Make follow-ups on outstanding matters on behalf of the Legal Services department in the office.
• Ensure all office requests are handled and responded to within set timelines.
• Ensure availability of stationery within the department.

Meeting and Diary Management

• Arrange meetings on behalf of the Legal Services Department.
• 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.

Document Control

• Ensure that the filing system is always up-to-date and functional.
• Collate court rolls received from the Registrar for the responsible court divisions, update references and distribute to state attorneys
• 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. 
• Collate all the court directives and update on the court directives database
• Maintain status update and records of all high value foreign national records for re-insurance purposes and report regularly

Qualifications and Experience

• National Diploma in Business Administration/Law related qualification. 
• Relevant 2 years' experience in a business/law administration related environment.

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Key Performance Areas

Legal cost management

• Keep up-to-date wih all incoming claims.
• Read and interpret claims.
• Review claims to ensure no fradulant or contradictory claims are made.
• Determine if a claim requires the services of an attorney.
• Determine the actual fees due to an attorney for each case.
• Ensure all payments to attorney’s are fair and reasonable.
• Consult different service providers to understand where the organisation could save on legal fees..

Quality assurance

• Ensure that invoicing processes are implemented and maintained at the highest standards.
• Maintain the implementation of 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 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 an insurance, legal or accounting related environment.

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Key Performance Areas

Offer Management

• Quality assure the type of offer made.
• Identify and correct any defects in consultation with the originator of the offer.
• Provide recommendations to the manager and team leader on settlement offers.
• Communicate approved offer.
• Request payment to be made.

Exeption Handling

• Assess the basis of the rejected offer.
• Make necessary adjustment on the initial offer and communicate.
• Suspend the claim until the dispute is resolved.

Quality assurance

• Ensure that legal costing processes are implemented and maintained at the highest standards.
• Maintain the implementation of an unusual occurrence procedures

Administrative support

• Document and upload offers on the system.
• Adequate provision of 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 Health Sciences or Law related qualification.

Experience

• Relevant 3 years’ experience in an insurance 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, 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.