Job title : Consultant: Loss of Earnings: Adjudication
Job Location : Western Cape, Cape Town
Deadline : December 21, 2024
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Key Performance Areas
Loss of earning adjudication
Confirm and record medical management recommendations.
Review the claim against the loss of earnings adjudication standards.
Check injury documents substantiating an ability to earn an income and make a determination.
Analyse the age, qualification level and skillset of the claimant to determine whether the applicant qualifies for an LOE.
Make a determination on the whether the injured is able to earn income or not as well as whether the injured is major or minor.
Apply applicable case laws and Statutory limit to determine the LOE quantum.
Schedule the injured for medical assessment in line with the findings.
Make recommendations on an appropriate amount of money for pay out per case.
Quality assurance
Adjucate the LOE product claim in line with the approved policy /SOP.
Participate in the consultations process on the implementation of programs and services.
Ensure that programs and services are implemented and maintained at the highest standards.
Implement the development and implementation of an unusual occurrence procedures.
Quality assure the loss of earning claims before they can be progressed to the next phase of the claims processing.
Administrative support
Record and document proof affirnity.
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 risk.
Provide ad hoc reports on process improvement initiatives.
Stakeholder management
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 related qualification.
Experience
Relevant 3 years' experience in claims adjudication related environment.
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