Note: This is a 12-month, fixed-term contract position Purpose of the job: The Consultant: LOE Adjudication is responsible for the processing of claimant applications with regards to loss of earnings.
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. Analyze the age, qualification level and skillset of the claimant to determine whether the applicant qualifies for an LOE. Make a determination on whether the injured is able to earn an 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 payout per case. Quality assurance Adjudicate 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 to 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 of affinity. 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 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 a related qualification Experience Relevant 3 years' experience in a claims adjudication related environment Technical and behavioral competencies required Claims management process/ processes and systems Complex problem identification, solving and decision making Customer value proposition Good financial management skills Strong analytical capabilities Knowledge of Motor Vehicle Accident legislation PFMA knowledge Planning, Organising and Coordinating Personal Mastery Judgement and Decision Making Ethics and Values Client Service Orientation NB: "RAF offers Total Employment Cost packages with no additional contributions from the Employer, successful candidates are required to structure their packages in a manner that will suit their needs." Note: This is a 12-month, fixed-term contract position Purpose of the job: The Consultant: LOE Adjudication is responsible for the processing of claimant applications with regards to loss of earnings.
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. Analyze the age, qualification level and skillset of the claimant to determine whether the applicant qualifies for an LOE. Make a determination on whether the injured is able to earn an 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 payout per case. Quality assurance Adjudicate 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 to 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 of affinity. 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 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 a related qualification Experience Relevant 3 years' experience in a claims adjudication related environment Technical and behavioral competencies required Claims management process/ processes and systems Complex problem identification, solving and decision making Customer value proposition Good financial management skills Strong analytical capabilities Knowledge of Motor Vehicle Accident legislation PFMA knowledge Planning, Organising and Coordinating Personal Mastery Judgement and Decision Making Ethics and Values Client Service Orientation NB: "RAF offers Total Employment Cost packages with no additional contributions from the Employer, successful candidates are required to structure their packages in a manner that will suit their needs."
