Key Performance Areas

Verification and Validation.

• Apply sound legal RAF Act and Regulations to Act, Case Law) knowledge on daily basis to validate claims.
• Search for and apply relevant Case Law during verification and validation.
• Determine the need to call in the injured for questioning in line with the RAF act.
• Apply RAF procedures to validate the claims.
• Assess duplicate claims to address mandates and minimise further processing of duplicate claims.
• Examine and apply the prescription of rules at the claim and product level.
• Verify data and information with relevant stakeholders.
• Assess the validity of death benefits products to determine locus standi.

Quality assurance

• Maintain and update necessary reporting standards as per standard operating procedure.
• Adequate and sound quality assurance.
• Ensure that verification and validation are maintained at the highest standards.
• Maintain the implementation of an unusual occurrence procedure.

Administrative support

• Document the acknowledge pre assessed 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.

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.

Reporting

• Track and report against set objectives and targets.
• Report on emerging risks.
• Provide ad hoc reports on process improvement initiatives.

Qualifications

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

Experience

• Relevant 3 years’ experience in the Claims environment.