Note: This is a 12-month, fixed-term contract position Purpose of the job: The Consultant: Merits is responsible for the assessment of merits to determine RAF liability as well as obtain information from various stakeholders in order to assess the merits for claims.
Key Performance Areas Merits management Compare the data on the accident information Centre against the claim to determine RAF liability. Categorize merits assessment using RAF defined merits classification (driver/non driver). Thoroughly investigate the merits of a claim/assessment of the merits file. Apply merits scenarios and rules to determine merits outcomes. Complete all necessary checklists and apply application categorization rules. Determine the need for a referral to claims investigation unit for further investigation and analyze the outcomes. Record merits outcome and generate the offer. Submit the offer-to-offer management for further communication to the claimant. Quality assurance Quality assures the outcomes liability determination and captures the reasons for disagreement. Ensure that merits processes are implemented and maintained at the highest standards. Maintain the implementation of an unusual occurrence procedure. Administrative support Verify registered merits information against Accident data Centre. 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. Qualifications Bachelor's Degree/ Advanced Diploma in a Health Sciences or Law related qualification. Experience Relevant 3 years' experience in an insurance/ investigations/ claims related environment. Technical and behavioral competencies required Understanding of post claim management and settlement. Medical bill reviewing. Medical case management. 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. Knowledge of budgeting, sales, business development, and strategic planning. Planning, Organizing 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: Merits is responsible for the assessment of merits to determine RAF liability as well as obtain information from various stakeholders in order to assess the merits for claims.
Key Performance Areas Merits management Compare the data on the accident information Centre against the claim to determine RAF liability. Categorize merits assessment using RAF defined merits classification (driver/non driver). Thoroughly investigate the merits of a claim/assessment of the merits file. Apply merits scenarios and rules to determine merits outcomes. Complete all necessary checklists and apply application categorization rules. Determine the need for a referral to claims investigation unit for further investigation and analyze the outcomes. Record merits outcome and generate the offer. Submit the offer-to-offer management for further communication to the claimant. Quality assurance Quality assures the outcomes liability determination and captures the reasons for disagreement. Ensure that merits processes are implemented and maintained at the highest standards. Maintain the implementation of an unusual occurrence procedure. Administrative support Verify registered merits information against Accident data Centre. 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. Qualifications Bachelor's Degree/ Advanced Diploma in a Health Sciences or Law related qualification. Experience Relevant 3 years' experience in an insurance/ investigations/ claims related environment. Technical and behavioral competencies required Understanding of post claim management and settlement. Medical bill reviewing. Medical case management. 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. Knowledge of budgeting, sales, business development, and strategic planning. Planning, Organizing 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."
