Road Accident Fund
The Road Accident Fund (RAF) is a state-owned insurer that provides cover to all motor vehicle drivers in South Africa for liability incurred or damages caused by traffic collisions. The RAF’s mandate excludes coverage for property damage such as vehicles, buildings, or vehicle contents. The Team Lead position at Menlo Park, Gauteng, focuses on overseeing the merits management process and ensuring effective claims handling, operational management, and quality assurance within the RAF.
Key Responsibilities
Merits Management
- Scrutiny of Claims: Review and assess claim documentation, including payslips, medico-legal reports, and hospital records, to ensure the accuracy and completeness of the claim.
- Offer Management: Ensure that appropriate compensation offers are made to claimants based on the merits of the case.
- Supervision: Manage assessors by supervising their work, providing guidance, and ensuring the work is completed to a high standard.
- Calculation and Analysis: Generate and compare various calculation results, interpreting data from reports to determine fair compensation amounts.
- Escalated Matters: Address and resolve escalated cases in the claims process, ensuring swift resolution.
- Liability Determination: Oversee the process of determining liability, ensuring compliance with established procedures and policies.
- Quality Assurance: Review merits outcomes, ensuring the accuracy and appropriateness of the offers made, and submit them for further approval and communication with claimants.
- Expert Appointments: Approve the appointment of relevant experts to assess liability and provide further guidance to subordinates on the merits process.
- Claims Investigation: Assess the need for further investigation into claims, providing justification for any additional steps.
Quality Assurance
- Accident Information: Ensure the accuracy and reliability of information related to merits at the Accident Information Centre.
- Consultation Participation: Engage in consultations regarding the implementation of programs and services aimed at improving processes.
- Service Standards: Ensure that all programs and services related to claims are implemented and maintained at the highest quality standards.
- Unusual Occurrences: Implement procedures for managing unusual occurrences during the claims process.
Exception Handling
- Tracking and Reporting: Develop and implement tracking methods to analyze and report on business case scenarios related to exception handling.
- Process Development: Establish and maintain formal processes for managing exceptions within the claims handling process.
- Policy and Procedure Updates: Regularly update documentation, policies, and procedures related to exception handling and ensure alignment with divisional needs.
Stakeholder Management
- Relationship Building: Foster proactive relationships with key stakeholders to ensure smooth communication and collaboration.
- Inquiries and Information Requests: Manage inquiries from internal and external stakeholders, providing timely and accurate information.
- Vendor and Procurement Management: Maintain strong relationships with vendors, service providers, and procurement teams to ensure timely invoicing and payments.
Reporting
- Regulatory Reporting: Prepare and submit reports in compliance with regulations, ensuring accuracy and timeliness.
- Operational Progress: Provide quarterly updates on the progress of operational plans and implementation.
- Functional Reporting: Develop functional reporting systems, including project and performance reporting, for effective management oversight.
- Policy and Procedure Alignment: Ensure the development and alignment of reports, policies, and procedures with the RAF’s overall strategy.
- Management Reports: Ensure regular reporting to provide updates on progress and inform management decisions.
People Management
- Team Motivation: Foster a cohesive and motivated team, ensuring alignment with the RAF’s strategic goals.
- Performance Management: Oversee staff performance, ensuring that departmental objectives are met and aligned with the overall strategic direction of the organization.
Qualifications and Experience
- Education: Bachelor’s Degree or Advanced Diploma in Health Sciences or a Law-related qualification.
- Experience: A minimum of 5 years of experience in an insurance or investigations environment, with at least 2 years in operations management.
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