Company:
Road Accident Fund
Industry: Government
Deadline: Not specified
Job Type: Contract
Qualification: Bachelors, Higher National Certificate, National Certificate
Experience: 3 years
Province: Eastern Cape
City: East London
Field: Insurance
Key Performance Areas
Claims Handling
- Ensure the correctness of the interpretation of the settlement, the undertaking, any limitations and or the past medical expenses to determine the Funds liability for future costs to be incurred.
- Ensure that any discrepancies are corrected by the re drafting of the undertaking to reflect the correct liability.
- Ensure that cognisance is taken of all expert reports, of internal and external origin, as well as the Medical and Legal assessment to determine the Funds liability for the costs incurred.
- Pre-authorise costs still to be incurred in terms of the undertaking within the mandate and in line with the medical and legal assessment.
- Recommend or approve payment of the costs as per the mandate; or repudiate the costs; or request more information or refer for medical intervention.
- Ensure that matters are referred to field Case Managers for further investigation.
- Ensure that the need for home visits are timeously identified and attended to when required.
- Ensure that the appropriate experts are appointed to do further assessments.
- Ensure the accurate quantification of undertakings.
Perform undertakings information audit
- Ensure the update in any change in the settlement details on the undertaking system to ensure that the liability of the Fund is accurately reflected on the system.
Qualifications
- NQF 7 (bachelor’s degree or Advanced Diploma) related qualification to discipline.
Experience
- Relevant 3 years’ experience in the claim’s environment.
