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The Road Accident Fund is a state insurer established by statute, it provides insurance cover to all drivers of motor vehicles in South Africa in respect of liability incurred or damage caused as a result of a traffic collision. Liability incurred in relation to property damage (such as damage to vehicles, buildings, vehicle contents) is excluded from cover.
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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
- Bachelor’s Degree or Advanced Diploma in nursing/ Allied Health Professions or related qualification
- 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.
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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
- Bachelor’s degree or Advanced Diploma in Nursing/ Allied Health Professions or related qualification.
- 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.
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Key Performance Areas
Policy Review and Implementation
- Contribute to the development and implementation of departmental policy, procedures and processes.
- Keep up to date with effective policy and practice execution strategies.
Preparation and Research on Related Litigation Matters
- Conduct research that will provide information in preparation for all matters for trial.
- Consult with client departments/ representatives, and witnesses for instructions and documentation for cases to be presented in Court.
- Draft pleadings to provide clear motivation/justification on a particular position about the case.
Mediation Process
- All required steps regarding the mediation process, as governed by the amendment to the rules of court, are to be taken.
- Upon conclusion of the mediation, parties shall inform Registrar and all other parties by a notice that Mediation is completed.
- Parties & Mediator must within 5 days of completion of mediation issue a joint minute indicating.
Represent the Road Accident Fund on all third party claims related litigation matters
- Attend court appearances in all allocated third-party litigation matters.
- Ensure file administration from opening to the conclusion of a legal case including adherence to trial dates.
- Handle appearances at courts, tribunals, mediation hearings and inquiries.
- Coordinate administrative legal actions to ensure compliance.
- Approve instructions to appoint and instruct expert witnesses.
Settle non-litigious matters before they are set down for trial
- Block consultation, early assessment of files, and early instructions to experts and assessors.
- Approve requests to appoint and instruct assessors and expert witnesses.
- Recommend a settlement.
Provision of legal advice to RAF
- Provide legal advice on arising legal matters and contracts.
- Provide well-researched legal advice on matters impacting the organisation.
- Conduct legal research and prepare legal opinions.
Taxation
- Deliver a full range of tax services in compliance with laws and regulations.
- Build relationships and interact with clients to provide consulting and expertise in tax services.
- Provide innovative tax planning and review complex income tax returns
Reporting
- Prepare and submit regulation reports as and when required to provide progress updates and/or inform management decisions.
- Develop reports/ policies/ procedures and guide the process through the alignment of the documents to the overall RAF’s Strategy.
- Develop functional reporting systems, for management, projects or performance reporting.
- Prepare proposals, briefings, presentations, reports, and other documentation and provide management information both verbally and in report format.
Stakeholder Management
- Facilitate and manage communication with relevant internal and external stakeholders in relation to investments and proactively and progressively manage the relationships.
- Manage relationships with vendors, service providers or procurement teams and ensure that all relevant procured items are invoiced and paid on time.
- Communicate with all levels of stakeholder contact.
People management
- Ensure the sourcing, development and retention of a high-performance team.
- Manage the recruitment of the operational workforce in line with employment equity targets.
- Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of the RAF.
- Manage the implementation of human capital processes and procedures to control/regulate workplace conflict and/or institute corrective measures and consultation processes to address deviations from standards.
- Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals.
Qualifications
- Bachelor’s Degree in Law or equivalent.
- Postgraduate in Law or equivalent.
- Admission as an Attorney of the High Court or Advocate.
- Right of appearance in the High Court.
Experience
- Relevant 5-7 years legal experience post-graduation or admission of which 2 years must have been on area of expertise (personal injury litigation).
go to method of application »
Key Performance Areas
Policy Review and Implementation
- Contribute to the development and implementation of departmental policy, procedures and processes.
- Keep up to date with effective policy and practice execution strategies.
Preparation and Research on Related Litigation Matters
- Conduct research that will provide information in preparation for all matters for trial.
- Consult with client departments/ representatives, and witnesses for instructions and documentation for cases to be presented in Court.
- Draft pleadings to provide clear motivation/justification on a particular position about the case.
Mediation Process
- All required steps regarding the mediation process, as governed by the amendment to the rules of court, are to be taken.
- Upon conclusion of the mediation, parties shall inform Registrar and all other parties by a notice that Mediation is completed.
- Parties & Mediator must within 5 days of completion of mediation issue a joint minute indicating.
Represent the Road Accident Fund on all third party claims related litigation matters
- Attend court appearances in all allocated third-party litigation matters.
- Ensure file administration from opening to the conclusion of a legal case including adherence to trial dates.
- Handle appearances at courts, tribunals, mediation hearings and inquiries.
- Coordinate administrative legal actions to ensure compliance.
- Approve instructions to appoint and instruct expert witnesses.
Settle non-litigious matters before they are set down for trial
- Block consultation, early assessment of files, and early instructions to experts and assessors.
- Approve requests to appoint and instruct assessors and expert witnesses.
- Recommend a settlement.
Provision of legal advice to RAF
- Provide legal advice on arising legal matters and contracts.
- Provide well-researched legal advice on matters impacting the organisation.
- Conduct legal research and prepare legal opinions.
Taxation
- Deliver a full range of tax services in compliance with laws and regulations.
- Build relationships and interact with clients to provide consulting and expertise in tax services.
- Provide innovative tax planning and review complex income tax returns
Reporting
- Prepare and submit regulation reports as and when required to provide progress updates and/or inform management decisions.
- Develop reports/ policies/ procedures and guide the process through the alignment of the documents to the overall RAF’s Strategy.
- Develop functional reporting systems, for management, projects or performance reporting.
- Prepare proposals, briefings, presentations, reports, and other documentation and provide management information both verbally and in report format.
Stakeholder Management
- Facilitate and manage communication with relevant internal and external stakeholders in relation to investments and proactively and progressively manage the relationships.
- Manage relationships with vendors, service providers or procurement teams and ensure that all relevant procured items are invoiced and paid on time.
- Communicate with all levels of stakeholder contact.
People management
- Ensure the sourcing, development and retention of a high-performance team.
- Manage the recruitment of the operational workforce in line with employment equity targets.
- Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of the RAF.
- Manage the implementation of human capital processes and procedures to control/regulate workplace conflict and/or institute corrective measures and consultation processes to address deviations from standards.
- Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals.
Qualifications
- Bachelor’s Degree in Law or equivalent.
- Postgraduate in Law or equivalent.
- Admission as an Attorney of the High Court or Advocate.
- Right of appearance in the High Court.
Experience
- Relevant 5-7 years legal experience post-graduation or admission of which 2 years must have been on area of expertise (personal injury litigation).
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Key Performance Areas
Contribute to OHS Strategies
- Contribute to the development and maintenance of OHS strategy.
- Proactively promote the OHS of all employees, visitors and contractors.
- Develop and maintain the OHS and safety strategies through facilitation.
- Development of effective codes and standards to address occupational health and safety hygiene.
- Analyse and compile OHS reports.
- Develop and implement National Occupational Disease prevention programme.
OHS and Contingency Planning
- Conduct threat or risk analysis and recommend proactive and reactive plans.
- Conduct fire risk assessment in order to develop fire prevention strategy and program.
- Develop and implement contingency plan.
- Participate in emergency management committee and organize such meetings.
- Liaise with fire department, disaster management centre and SAPS on evaluation and endorsement of the contingency plan.
- Review and update contingency plan on annual basis.
- Co-ordinate emergency or fire drill evacuation at least once a year.
Conduct OHS Special Investigations and Reporting
- Investigate all OHS incidences.
- Report all incidences to Facilities/OHS and Administration Manager.
- Record all OHS incidences to incident register.
- Conduct incident investigations on reportable incidents.
Perform OHS Audits
- Participate in establishing OHS audit schedule.
- Conduct internal audits, workplace inspections and investigate complaints.
- Analyse trends and feedback obtained through incident or audit reports.
Workers Compensation or Injury Management
- Ability to maintain confidentiality at all times.
- Process workers Compensation claims.
- Liaise with rehabilitation specialists, HR and EWS to ensure documentation and application of rehabilitation procedures are followed.
- Conduct incident and accident investigations and compile a report
- Participate in the review of relevant policies and procedures.
OHS Champion Management
- Ensure OHS committee members attend meetings.
- Train OHS or committee members & employees and conduct awareness programs.
- Ensure that tasks are being performed and that the representatives follow the correct procedures.
- Training of all personnel to ensure that they are aware of their functions.
- Ensure monthly meetings with organised labour and Committee Chairpersons to discuss OHS matters.
Qualifications and Experience
- Bachelor’s Degree/ Advanced Diploma in Occupational Health and Safety related qualification.
- Certificate in First aid training.
- Certificate in Firefighting training.
- Certificate in SAMTRAC would be an added advantage.
- Relevant 3 years working experience in Occupational Health and safety related environment.
- Experience of the OHS Act, SABS and ISO 2001 regulations.
Method of Application
Use the link(s) below to apply on company website.
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