Vacant Jobs at Road Accident Fund

Key Performance Areas

Policy Review and Implementation

• Contribute to the development and implementation of departmental policy, procedures and processes.
• Keep up to date with effective policy and practice execution strategies.

Preparation and Research on Related Litigation Matters

• Conduct research that will provide information in preparation for all matters for trial.
• Consult with client departments/ representatives, and witnesses for instructions and documentation for cases to be presented in Court.
• Draft pleadings to provide clear motivation/justification on a particular position about the case.

Mediation Process

• All required steps regarding the mediation process, as governed by the amendment to the rules of court, are to be taken.
• Upon conclusion of the mediation, parties shall inform Registrar and all other parties by a notice that Mediation is completed.
• Parties & Mediator must within 5 days of completion of mediation issue a joint minute indicating.

Represent the Road Accident Fund on all third party claims related litigation matters

• Attend court appearances in all allocated third-party litigation matters.
• Ensure file administration from opening to the conclusion of a legal case including adherence to trial dates.
• Handle appearances at courts, tribunals, mediation hearings and inquiries.
• Coordinate administrative legal actions to ensure compliance.
• Approve instructions to appoint and instruct expert witnesses.

Settle non-litigious matters before they are set down for trial

• Block consultation, early assessment of files, and early instructions to experts and assessors.
• Approve requests to appoint and instruct assessors and expert witnesses. 
• Recommend a settlement.

Provision of legal advice to RAF

• Provide legal advice on arising legal matters and contracts.
• Provide well-researched legal advice on matters impacting the organisation.
• Conduct legal research and prepare legal opinions.

Taxation

• Deliver a full range of tax services in compliance with laws and regulations.
• Build relationships and interact with clients to provide consulting and expertise in tax services.
• Provide innovative tax planning and review complex income tax returns

Reporting

• Prepare and submit regulation reports as and when required to provide progress updates and/or inform management decisions.
• Develop reports/ policies/ procedures and guide the process through the alignment of the documents to the overall RAF’s Strategy.
• Develop functional reporting systems, for management, projects or performance reporting.
• Prepare proposals, briefings, presentations, reports, and other documentation and provide management information both verbally and in report format.

Stakeholder Management

• Facilitate and manage communication with relevant internal and external stakeholders in relation to investments and proactively and progressively manage the relationships.
• Manage relationships with vendors, service providers or procurement teams and ensure that all relevant procured items are invoiced and paid on time.
• Communicate with all levels of stakeholder contact.

People management

• Ensure the sourcing, development and retention of a high-performance team.
• Manage the recruitment of the operational workforce in line with employment equity targets.
• Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of the RAF.
• Manage the implementation of human capital processes and procedures to control/regulate workplace conflict and/or institute corrective measures and consultation processes to address deviations from standards.
• Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals.

Qualifications

• Bachelor’s Degree in Law or equivalent.
• Postgraduate in Law or equivalent.
• Admission as an Attorney of the High Court or Advocate.
• Right of appearance in the High Court.

Experience

• Relevant 5-7 years legal experience post-graduation or admission of which 2 years must have been on area of expertise (personal injury litigation).

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Key Performance Areas

Conduct Preliminary assessment of litigated files

• Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to cotribute to a reduced legal costs ratio.
• Report complex, severe exposure claims for reinsurance purposes.
• Assessment and settlement of loss of earnings.
• Ensure efficient and cost effective finalization of claims through settlement negotiations.
• Perform assessment of merits and quantum.
• Assess general damages in terms of old and new Act.
• Assess settlement of loss of support.
• Assess settlement of funeral expenses.
• Assess settlement of medical expenses. 
• Block settlement. 
• Appoint assessors for merits and quantum verification.
• Loading of court orders.
• Perform writs assessment and reporting.
• Perform approval of offers.
• Perform bridge assessment and reporting. 

Escalate matters with litigious disputes to pleadings processes

•  Verify and analyze data used in settling litigated claims to ensure that there is a litigious dispute and that decisions for further litigation process are made according to company practices, policies and procedures.

Provide RAF Attorneys with file contents for trial preparation

• Confer with RAF  Attorney’s legal counsel on the litigation strategy to be embarked on in preparation of trial and receive requests for approval in terms of the delegation of authority. 
• Ensure high court practice notes are followed.
• Evaluate outstanding information.
• Assess claims for possible settlement.
• Evaluate expert medico legal reports.
• Follow up on outstanding information until all documents has been received.
• Repetitive diarising on 6th weekly basis.

Report on trial outcomes and out of court settlements

• Examine claims investigated by RAF Attorneys; further investigate questionable claims to determine whether to authorize settlements or tenders.

Qualification 

• Four (4) years Degree in Law or equivalent
• Admission as an Attorney of the High Court or Advocate.

Experience 

• Relevant 3 years experience in the claims /litigation environment 

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Key Performance Areas

Policy review and implementation

• Provide input into the enhancement and implementation of the case management policies and strategy and plan to ensure an alignment with short-term and long-term objectives.
• Manage the implementation of the case management strategy approved, including as appropriate any special tasks or projects requested by management. 

Clinical Care Management

• Manage the clinical status of claimants in accordance with the prescribed requirements throughout the case management process.
• Manage the provision of clinical assessments to ensure that admissions adhere to approved criteria.
• Ensure an accurate, appropriate, and complete diagnostic and procedural coding of all claimants records. 
• Manage the assessment of medical problems of the injured and the provision of quality of care.
• Identify training needs of the Senior Officers: Hospital Case Management in line with the scope of work and the changes in the processes 

Manage the provision of patient care 

• Substantiate claimant hospitalisation in terms of treatment, length of stay and level of care.
• Ensure that a comprehensive assessment for claimants is performed and that a follow-up in accordance with the schedule determined/ agreed is undertaken.
• Ensure the monitoring of claimant treatment recovery progress to recommend adjustments where necessary.
• Ensure that the claimants focused plan of care is coordinated and communicated to ensure attention is being focused on progression towards discharge.
• Ensure that the quality of health care provided to claimant is monitored to ensure they are up to acceptable standard.
• Manage and ensure that the discharge plan for the claimant is effective and allows for continued treatment after hospital discharge.
• Ensure that claimants have the necessary utilities and amenities required for complete recovery.
• Provides alternative treatment options to ensure a cost effective and efficient plan of care.
• Manage and fast track case management reports and recommendations relating to the issuing of Undertaking Certificate and Interim Undertaking Certificates.
• Analyse and approve the recommendations for the transfer of claimants to better facilities of care. 

Case management and administration

• Manage all assigned cases.
• Manage the development of practice and/or clinical guidelines for cost effective care.
• Intervene on clinical discussion relation to the care of MVA claimants as per the SLA and MOU. 
• Present cases at case rounds/conferences to obtain multidisciplinary perspective & recommendations to achieve optimal outcomes.
• Manage the provision of claimants care plan and compliance reporting.
• Manage claimants case management plans, authorizations, assessment, and levels of care.
• Manage the review of medical records to identify specific medical issues. 
• Identify financial and business risks to the Fund and escalate accordingly.
• Analyse claimants care reports and make recomemndations in prepation of the rehabilitation handover post discharge.
• Manage high cost hospital cases and establish a forum for case managers to present high cost cases. 

Manage the submission of invoices

• Validate and quality assure invoices submitted to ensure that they are aligned to the services and treatments claimed for.
• Ensure financial and case management documentation supports accurate record-keeping and future requirements.
• Put measures in place to safeguard againts the submission of fraudulent invoices.
• Manage the compliance of invoiced services from service providers and ensure validity in line with RAF Act and guidelines.
• Manage timeous payment of healthcare proffesionals for service rendered. 

Reporting

• Prepare and submit monthly and quarterly performance reports or as and when required to provide progress updates and/or inform management decisions.
• Develop functional reporting systems for case management, projects or performance reporting.
• Prepare proposals, briefings, presentations, reports, and other documentation and provide management information both verbally and in report format. 

Stakeholder Management 

• Engage in hospital visits where needed to build stakeholder relationships, proactively resolve queries and increase visibility to claimants.
• Build productive relationships with healthcare professionals to ensure adequate referral rates to achieve budgeted occupancy level.
• Build professional, long-term relationships with Funders and other stakeholders.
• Ensure accurate service knowledge and advice and keep stakeholders informed of products and service options.
• Manage the resolution of stakeholder queries and complaints promptly. 

People Management

• Ensure the sourcing, development and retention of a high-performance team.
• Manage the recruitment of the operational workforce in line with employment equity targets.
• Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of the RAF.
• Manage the implementation of human capital processes and procedures to control / regulate workplace conflict and/or institute corrective measures and consultation processes to address deviations from standards.
• Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals. 

Qualifications 

• Bachelor’s Degree/Advanced Diploma in Health sciences or Medical related Degree.
• Postgraduate in Health Sciences or Medical related qualification will be an added advantage.
• Registration with the relevant Health Professional Council body. 

Experience

• Relevant 6-8 years’ experience in Nursing or Case Management environment of which 2 (two) years must have been on a management/supervisory level/area of expertise.
• ICU/Theatre or High cost Case Management experience will be an advantage.