Consultant: General Damages

1 week ago


Cape Town, Western Cape, Saudi Arabia Road Accident Fund Full time

Purpose of the Job:

The Consultant: General Damages Adjudication is responsible for or the processing of claimant applications with regards to general damages adjudication.

Key Performance Areas

General damages adjudication

  • Review the claim against the general damages adjudication standards.
  • Identify falsified general damages related injuries and report them.
  • Confirm and record medical management recommendations.
  • Apply relevant controls and tools to generate general damages offer, i.e,book of quantum.
  • Calculate general damage product and make an offer.
  • Process the offer to be communicated to the claimant following the appropriate channels.

Quality assurance

  • 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 an unusual occurrence procedures.

Administrative support

  • 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 riks.
  • 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 the predefined turnaround times.

Qualifications and Experience

  • Bachelor's Degree/Advanced Diploma in Health Sciences related qualification to discipline.

Experience

  • Relevant 3 years' experience in a claims adjudication related environment.

Competencies

Behavioural:

  • Planning, Organisation and coordinating.
  • Personal mastery.
  • Judgement and Decision Making
  • Ethics and values.
  • Client service orientation.

Technical:

  • Claims assessment and settlement process and systems including handling, general damages assessment and settlement
  • Medical case management.
  • Complex problem identification, solving and decision making.
  • Claims management processes and systems.
  • Customer value proposition.
  • Good financial management skills.
  • Strong analytical capabilities.
  • Knowledge of Motor Vehicle Accident legislation.
  • PFMA knowledge.

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