Consultant: LOS Adjudication X3 needed at Road Accident Fund

Key Performance Areas 

Loss of support adjudication

• Review the claim against the loss of support adjudication standards.
• Assess loss of support supporting documents and data to determine the deseased duty to support (confirming affirnity).
• Determine deceased ability to support the dependants by assesing income supporting data/documents in line with the approved quantum.
• Apply applicable case laws and Statutory limit to determine the LOE quantum.
• Based on the findings make a determination to reject or approve.
• Assess actuarial reports and make a determination to whether to instruct internal actuarial team to make actuarial calculation or not.

Quality assurance

• Research, analyse, and review policies and laws relevant to assigned cases
• Participate in the consultations process on the implementation of claims and related processes.
• Ensure that LOS Adjudication and processes are implemented and maintained at the highest standards.
• Maintain the 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 risks.
• 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 and Experience

• Bachelor’s Degree/Advanced Diploma in a related qualification to discipline
• Relevant 3 years’ experience in a claims adjudication related environment.