Note: This is a 12 Months Fixed Term Contract
Purpose of the Job: The Consultant: Loss of earnings- Adjudication is responsible for the processing of claimant application with regards to loss of earnings.
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.
Competencies
Behavioural:
- Planning, Organisation and coordinating.
- Personal mastery.
- Judgement and Decision Making
- Ethics and values.
- Client service orientation.
Technical:
- 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.
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 Months Fixed Term Contract
Purpose of the Job: The Consultant: Loss of earnings- Adjudication is responsible for the processing of claimant application with regards to loss of earnings.
