Note: This is a 12-month, fixed-term contract position Purpose of the job: The Consultant: Loss of Support Adjudication is responsible for the processing of claimant applications with regards to loss of support adjudication.
Key Performance Areas Loss of support adjudication Review the claim against the loss of support adjudication standards. Assess loss of support supporting documents and data to determine the deceased duty to support (confirming affinity). Determine deceased ability to support the defendants by assessing income supporting data/documents in line with the approved quantum. Apply applicable case laws and Statutory limit to determine the LOE quantum. Based on the findings, make a determination to reject or approve.
Assess actuarial reports and make a determination to whether to instruct internal actuarial team to make actuarial calculation or not. Make an offer and submit to offer management for further communication with the claimant. Quality assurance Research, analyse, and review policies and laws relevant to assigned cases. Participate in the consultations process on the implementation of claims and related processes. Ensure that LOS Adjudication and processes are implemented and maintained at the highest standards. Maintain the implementation 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. Reports 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 to discipline. 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: Loss of Support Adjudication is responsible for the processing of claimant applications with regards to loss of support adjudication.
Key Performance Areas Loss of support adjudication Review the claim against the loss of support adjudication standards. Assess loss of support supporting documents and data to determine the deceased duty to support (confirming affinity). Determine deceased ability to support the defendants by assessing income supporting data/documents in line with the approved quantum. Apply applicable case laws and Statutory limit to determine the LOE quantum. Based on the findings, make a determination to reject or approve.
Assess actuarial reports and make a determination to whether to instruct internal actuarial team to make actuarial calculation or not. Make an offer and submit to offer management for further communication with the claimant. Quality assurance Research, analyse, and review policies and laws relevant to assigned cases. Participate in the consultations process on the implementation of claims and related processes. Ensure that LOS Adjudication and processes are implemented and maintained at the highest standards. Maintain the implementation 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. Reports 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 to discipline. 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."
