Road Accident Fund Vacancies

Vacancies at RAF
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Road Accident Fund Vacancies

Road Accident Fund


Officer Capital Payment x 5

Division:  3300

Reference No:  3868

Location:  

Cape Town, Western Cape, ZA

Employment Type:  Fixed Term Contract

Disability (EE targeted role):  Yes

T.A.S.K Grade:  10

Job Posting Salary:  R434,656.00

Job Posting End Date:  5 Mar 2024

The Road Accident Fund’s mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.

NB: This is a 12 Months Fixed Term Contract Position

Purpose of the Job: To request capital payment.

Key Performance Areas

To request of capital payments

  • Request payments in terms of block settlement agreements.
  • Request payments in respect of capital for claimants and/or their representatives.
  • Request time frames within which payments are to be effected in terms of the court order.
  • Prevent delays in requesting payments.
  • Identify fraudulent payments and advise Forensics.
  • Identify and record interim payments to prevent duplicate payments.
  • Compile a schedule of files where settled or capital payment is to be requested.
  • Check and prevent duplicate payments.
  • Follow up on delayed/pending payments.

Provide customer services to clients of the RAF

  • Attend to queries from both internal and external stakeholders.
  • Provide advice and guidance to Claims sections in respect of duplicate or dummy files.
  • Identify referrals to Recourse and Recoveries.
  • Request termination of mandates where necessary before effecting payments.

Collate and compile statistics as required

  • Record and maintain statistics on Payments requests.
  • Monitor and report on failed payments.
  • Keep daily stats of activities on work allocated and work to be done.
  • Submit daily, weekly and monthly stats as required.

Render advisory responsibilities

  • Attend to queries from stakeholders pertaining to capital payments outstanding.
  • Provide feedback on payments to claims sections and attorneys.

Provide office administrative services

  • Pre-screen files to ensure that they belong to the correct department of the RAF.
  • Validate that the correct banking details are loaded on the system prior to requesting payment.
  • Verify and validate that the payment is requested to the correct payee.
  • Receive and record files where capital payments are to be requested after concluding the validation process.
  • Updating the information on the files to correlate with the claims system iro claim number, link number, claimants and attorneys details.
  • Compile lists of finalized files to be forwarded to CAFS.
  • Request and return files from CAFS and claims when required.
  • Attend to queries.
  • Update the status and allocation of files on claims view system.
  • Maintain accurate records of files where capital payments are to be requested.
  • Keep records of movement of all files.  

Qualifications and Experience

  • NQF 7 (Bachelor’s Degree or Advanced Diploma) related qualification to discipline.
  • Relevant 3 years’ experience in claims system, MVA procedures and knowledge of court processes environment.

Technical and behavioral competencies required

  • Communication (written, verbal and listening skills).
  • Customer service orientation.
  • Professionalism.
  • Good organizational skills.
  • Problem solving skills.
  • Interpersonal Relations.
  • Team Player.
  • Planning and organizing.
  • Analytical thinking.
  • Conflict management.
  • Decision making skills.
  • Personal mastery
  • Emotional wisdom
  • Ethics and governance
  • Customer orientation and customer focus

NB: “RAF offers Total Employment Cost packages with no contributions from the Employer, successful candidates are required to structure their packages in manner that will suit their needs”.

The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.

Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful

Security Vetting shall be conducted on all prospective employees

It is the applicants’ responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

Apply now »


Consultant: Pre-Assessment X10

Division:  Claims

Reference No:  3891

Location:  

Cape Town, Western Cape, ZA

Employment Type:  Fixed Term Contract

Disability (EE targeted role):  Yes

T.A.S.K Grade:  10

Job Posting Salary:  R434,656.00

Job Posting End Date:  27 Feb 2024

The Road Accident Fund’s mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.

Note: This is a 6 Months Fixed Term Contract

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

Quality assurance.

  • Ensure that pre assessment processes are implemented and maintained at the highest standard.
  • Maintain the implementation an unusual occurrence procedures.

Administrative support.

  • Document the 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 the predefined turnaround times.

Qualifications

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

Experience

  • Relevant 3 years’ experience in the Claims environment.

Competencies

Behavioural:

  • Planning, Organising and Coordinating.
  • Personal mastery.
  • Judgement and Decision Making.
  • Ethics and Values
  • Client Service Orientation.

Technical:

  • 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 details.

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”

The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.

Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful

Security Vetting shall be conducted on all prospective employees

It is the applicants’ responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

Apply now »


 Create Alert

Apply now »

Senior Officer: Field Case Management X4

Division:  Claims

Reference No:  3900

Location:  

Cape Town, Western Cape, ZA

Employment Type:  Fixed Term Contract

Disability (EE targeted role):  Yes

T.A.S.K Grade:  12

Job Posting Salary:  R579,259.00

Job Posting End Date:  27 Feb 2024

The Road Accident Fund’s mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.

Note: This is a 6 Months Fixed Term Contract

Purpose of the Job:  To manage the rehabilitation and health care needs of the injured.

Key Performance Areas

Decision making regarding quality of care.

  • Assessment of ongoing medical problems of the injured after discharge in the home environment.
  • Assessment of patient according to prescribed measurements.
  • Assessment of burden of care and needs of the client.
  • Monitors of quality of care issues
  • Selection and monitoring clinical pathways.

Decision Making regarding collaboration.

  • Facilitates collaboration of service providers with client.
  • Protector of privacy and confidentiality.
  • Coordination of plan of care and services.
  • Facilitate caregiver’s appointments necessary for the client.
  • Facilitate timely consultation with appropriate medical service providers.
  • Facilitate family and clinical team communication.
  • Health educator and counsellor for client and family.
  • Utilization review.
  • Post discharge follow-through.

Decision making regarding advocacy criteria.

  • Conflict resolution expert and referee.
  • Liaison between patient and care team.
  • Negotiating and procuring resources and services from providers.
  • Benefit analysis.
  • Record keeping and documentation.
  • Maintain patient confidentiality.

Decision making regarding resource utilization.

  • Post discharge follow-through.
  • Drug utilization review.
  • Assistive devices necessary for client.
  • Home alterations.
  • Vehicle adaptations.
  • Vocational guidance after life changing event for client.
  • Placement of children in special schools.
  • Back to work opportunities.

Decision making regarding legal & ethical criteria.

  • Advise client of accident relatedness of his claim.
  • Decide reasonableness and appropriateness of service.
  • Advise whether altering homes and placing clients in rehab centres or institutions is appropriate.
  • Advice regarding payment of care givers taking into account patient autonomy, informed choice, medical implications and burden of care.

Pre-authorisation of admissions.

  • Arrange for hospital admission and advise patients on their benefit.

Assess medical Bills.

  • Assessment of bills received and advise claimants of outcomes of bill review.

Recommend payment.

  • Recommend payment of bills assessed.

Qualifications

  • NQF 6 (Diploma or Advanced Certificate) in Nursing or Allied Health Professions or related qualification to discipline.
  • NQF 7 (Bachelor’s Degree or Advanced Diploma) in nursing/ Allied Health Professions related qualification to discipline will be an added advantage.
  • Registration with the relevant Health professions council
  • Knowledge of ICD and CPT coding will be an advantage.
  • Valid code 8 driving license.

Experience

  • Relevant 4 years’ experience in the medical field of which 1 year is on supervisory level.
  • Experience in Managed health.

Competencies

Behavioural.

  •  Organisational Resilience.
  • Team Resilience.
  • Network and Alliances
  • Personal Mastery.
  • Judgement and Decision Making.
  • Emotional wisdom
  • Ethics and Governance.
  • Customer orientation and Customer Focus.

Technical.

  • People orientated.
  • Team player.
  • Adaptability, flexibility, and creativity.
  • Interpersonal & communication skills.
  • Strong sense of self-esteem and confidence.
  • Good follow-through
  • Self-directedness.
  • Caring attitude and behavior
  • Assertiveness skills
  • Analytical skills

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”

The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.

Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful

Security Vetting shall be conducted on all prospective employees

It is the applicants’ responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

Apply now »


Officer: Bill Review X4

Division:  Claims

Reference No:  3904

Location:  

Cape Town, Western Cape, ZA

Employment Type:  Fixed Term Contract

Disability (EE targeted role):  Yes

T.A.S.K Grade:  10

Job Posting Salary:  R434,656.00

Job Posting End Date:  27 Feb 2024

The Road Accident Fund’s mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.

Note: This is a 6 Months Fixed Term Contract

Purpose of the Job:  Review Medical Bills.

Key Performance Areas

Audit & review medical bills.

  • Analysis of claimed items/services in correlation with available tariff structures and ICD 10 /CPT 4 codes.
  • Requesting motivation for unreasonable accounts.
  • Line by line analysis of claim items/service. Matching those appropriate tariffs/ICD/CPT codes.
  • Flagging rejected items/services.
  • Recommendations to department responsible for processing payments.
  • Auditing medical claims and assisting in technical aspects of bill review.
  • Ensure that accounts submitted to the Fund from service providers are valid in terms of RAF guidelines and the Road Accident Fund Act.
  • Assess and monitor claims to curb over servicing or abuse and fraudulent claims.
  • Ensuring that the accounts are paid timeously according to the service level agreements.
  • Ensure that the services and treatments claimed are accident related/ (related to the accident under consideration).
  • Reduce future healthcare cost and improve efficiencies by analysing trends in in injured person’s use of services.
  • Compare outcomes and cost of different therapeutic modalities and surgical techniques and the information provided.
  • Manage future healthcare costs and improve efficiencies by analysing trends in utilization of services.
  • Formal assessment of medical necessity and appropriateness of procedures the will be in effective in curbing fraud and over servicing unreasonable demand of benefits from victims of road accidents.

Promote good working relations with Stake Holders.

  • Check and advise on the tariffs used on accounts.
  • Provided training on new developments.

Approve medical expenses in accordance with relevant DOA.

  • Authorisation in accordance with mandate.
  • Inform service provider of payment decision.

Assisting in technical aspects of bill review.

  • Develop and manage relationships with department of health services, government dept and other key external stake holders.

.

Check & approve Payments in terms of DOA.

  • Receive invoices and check payment request for accuracy and correctness.

Determine the level of care based on functional ability.

  • Analysis of medical data available e.g. Case Manager’s Reports, Clinical Records and Medico – Legal Reports.

Pre authorisation of procedures.

  • Analyse medical data to determine the need for the service.
  • Timeous assessment of urgent files e.g. Road Shows.

Qualifications

  • NQF 6 (Diploma or Advanced Certificate) in Nursing or Allied Health Professions or related qualification to discipline.
  • NQF 7 (Bachelor’s Degree/Advanced Diploma) in nursing/ Allied Health Professions related qualification to discipline will be an added advantage.
  • Registration with the relevant Health professions council.

Experience

  • Relevant 3 years’ experience in a medical field.

Competencies

Behavioural:

  • Personal mastery
  • Emotional Wisdom.
  • Ethics and Governance.
  • Customer orientation and customer focus.

Technical:

  •  Computer literacy.
  •  Ability to interpret the rules of the UPFS tariffs.
  •  Analytical skills.
  •  Organisational & Administrative skills
  •  Planning and Organising
  •  Decision making
  •  Negotiation skills.

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”

The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.

Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful

Security Vetting shall be conducted on all prospective employees

It is the applicants’ responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

Apply now »

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