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ROAD ACCIDENT FUND (RAF) - SENIOR CLAIMS SPECIALIST X3
ROAD ACCIDENT FUND (RAF)
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
The Organization requires the services of qualified individuals within its Head Office on a Three (3) Year Fixed Term Contract for the following position:-
THIS IS AN INTERNAL AND EXTERNAL ADVERTISEMENT
SENIOR CLAIMS SPECIALIST: T.A.S.K GRADE 18 X3
05062021SCS
LOCATION: Centurion
CLOSING DATE & TIME: 8/6/2021 11:55 PM
Purpose of the Job: The SENIOR CLAIMS SPECIALIST is accountable to oversee effective and efficient administration of all claims processes and systems within the RAF to deliver a high level of customer satisfaction. The role is also expected to drive implementation of the business operating model across the RAF processing centres.
Key Performance Areas
Claims Administration
- Establish and maintain appropriate systems to perform claims processing, medical administration and other claims related functions.
- Drive the provision of sound claims administration support to ensure a smooth claims experience for the claimants.
- Manage the implementation of automated processes of direct and indirect claims handling procedures and risk management processes that will enable a smooth claims process and foster transparency for the end user.
- Ensure that claims merits are thoroughly assessed and determination is based on accurate information.
- Liaise with other departments to identify improvements in claims process and procedure.
- Lead the effective and efficient provisioning of actuarial support and advice to the RAF business.
- Manage the implementation of a successful claims mediation process to minimize litigation of a claim.
- Ensure claims activities at a high level, comply with organisational requirements for quality management, legal stipulations, and general duty of care.
- Ensure claims are measured against operational risk systems and processes to govern threshold breaches.
- Contribute in the business strategies for RAF products and services.
- Identification and management of claims trend.
- Outlier management.
- Ownership of business process for authorisations and claims stream (reviewing, documentation and sign off).
- Ownership of the internal clinic authorisations system rules and functionality.
- Subject matter expert on claims and billing rules as well as identification, implementation and automation all of hospital claims billing rules.
- Development and Automation of clinical protocols and rules.
- Identify and implement any operational efficiency for claims, pre-authorization, case management, clinical protocol unit, risk management and the product development areas.
- Drive standardisation and re-engineering of current claims processes to enable them for process automation, digital initiatives, system deployments and new processes in line with new operating model.
- Improve operational efficiencies and identify opportunities for reducing operational costs
- Promote and develop a continuous improvement culture for claims processes across the RAF.
- Develop sound and quality reports for all relevant Committees for the RAF.
- Ensure data integrity across the merits department and consistency with other sources.
- Ensure monthly and quarterly claims related reports are created with an appropriate supporting analysis to identify any matters important for external commentary and for internal understanding of performance.
- Foster the use of business dashboards and reports that can be viewed by multiple stakeholders.
- Prepare and present management information and reports as required.
- Establish and maintain constructive and effective internal and external relationships with all key stakeholders and partners to ensure achievement of business objective.
- Develop and maintain ways of work with other functional areas to ensure a coordinated approach in delivering business initiatives and requirements.
- Build and maintain healthy and transparent relationships and rapport with internal and external stakeholders.
- Foster and advocate claims continuous improvement through coaching and applying problem solving tools and philosophies across the RAF.
- Provide sound advice on all escalated claims process and system related queries.
- Encourage an open culture for the continuous improvement of a high performance culture.
- Ensure proper planning and allocation of consistent workload within the business unit.
- Monitor performance of teams against planned activities.
- Identify and ensure sufficient training and development of employees within the business unit.
- Ensure that good employee's relations are maintained.
- Provide ongoing support and coaching for employees.
- Ensure that all employees have entered into performance contracts/agreements within the business unit.
- Conduct periodic employee's performance reviews and assessments.
Qualifications and Experience
- NQF 7 (Bachelor Degree) related qualification.
- Business qualification advantageous.
- Relevant 8-10 years' experience in the claims administration environment of which 3 (three) years must have been on management level.
- Experience in healthcare or insurance administration 3 – 5 years.
- Strategic capability and leadership
- Results orientation
- Business and financial acumen
- Brand and stakeholder orientation
- Organisational resilience
- Communication
- Resilient
- Network and alliances
- Inspire commitment
- Talent management
- Change management
- Knowledge of claims management, clinical protocols, systems, methods, processes standards and administration.
- Data & analytical, communication, leadership, managerial and organizational skills.
- Skilled in critical thinking, creativity in resolving unique and challenging business problems.
- Understanding of injury assessment, collating and synthesis of clinical reports and linking it to the claim submitted.
- Ability to do long-term planning, to create and manage budgets.
- Innovative
- Verbal and Communication skills.
- MVA legislation knowledge or Insurance claims administration advantageous
- Integrity
- Compassion
- Accountability
- Respect
- Excellence
Remuneration
Total cost to company applicable to this position is market-related
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".
Closing date: 06 August 2021
Applications can be forwarded to the Recruitment Officer at Eco Glades; email address is Thembi.recruitment@raf.co.za OR hand delivered at 420 Witch-Hazel Avenue, Eco Glades 2, Centurion.
INSTRUCTION TO PROSPECTIVE APPLICANTS
- Indicate the name and the reference number for the position you are applying for on the subject line
- Do not submit copies of qualifications and ID as these will be requested from shortlisted candidates on the interview date
- Submit a short CV with a maximum of 5 pages
- Please indicate your current salary and salary expectations if considered for the position.
NB: 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.