Consultant: Loss of Earnings: Adjudication

2 weeks ago


Cape Town, South Africa Road Accident Fund Full time
Job title : Consultant: Loss of Earnings: Adjudication Job Location : Western Cape, Cape Town Deadline : December 21, 2024 Quick Recommended Links
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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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