Claims Pre-Assessment Consultant

3 weeks ago


Johannesburg, Gauteng, South Africa Road Accident Fund Full time

Purpose of the Job: The Consultant: Pre-Assessment is responsible for the pre-assessment of prospective claims applications.

Key Performance Areas:

Pre-Assessment of Prospective Claims:

  • Record all submitted documents for prospective claims.
  • Determine benefits and products submitted based on submitted documents.
  • Assess submitted documents to determine compliance as per defined processes and rules.
  • Apply compliance and lodgment rules in pre-accessing the prospective claim.
  • Identify duplicate claims and linked claims.
  • Examine prescription of lodgment and apply prescription rules.
  • Verify mortality with Home Affairs.
  • Communicate assessment outcomes to prospective claimants.

Quality Assurance:

  • Ensure pre-assessment processes are implemented and maintained at the highest standards.
  • Maintain implementation of unusual occurrence procedures.

Administrative Support:

  • Document acknowledged claims.
  • 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 feedback to all stakeholders to keep them updated on the status of a query.
  • Respond to queries within predefined turnaround times.

Qualifications:

  • Bachelor's Degree/Advanced Diploma in a related qualification.

Experience:

  • Relevant 3 years' experience in the claims environment.

Technical and Behavioral Competencies Required:

  • Ability to differentiate different RAF Products.
  • Knowledge of Motor Vehicle Act.
  • 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.
  • Attention to detail.
  • Planning, Organizing, and Coordinating.
  • Personal Mastery.
  • Judgement and Decision Making.
  • Ethics and Values.
  • Client Service Orientation.

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.



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