Consultant: Merits (X4)

Road Accident Fund; East London; On-site; ZAR 435,000; Full time

Job summary

A road safety organization in East London is seeking a Consultant: Merits for a fixed-term contract. The role involves assessing claims merits and determining RAF liability while ensuring compliance within a structured framework. The ideal candidate should have a relevant degree and 3+ years of experience in a related position. This position offers a competitive salary structured to suit your needs.

Qualifications

• Relevant 3 years’ experience in an insurance/ investigations/ claims related environment.
• Medical bill reviewing experience.
• Knowledge of Motor Vehicle Accident legislation.

Responsibilities

• Assess merits to determine RAF liability.
• Investigate merits of claims thoroughly.
• Produce documents, briefing papers, reports, and presentations.

Skills

Understanding of post claim management

Complex problem identification

Strong Analytical capabilities

Education

Bachelor’s Degree/ Advanced Diploma in Health Sciences or Law

Job description

Division: Claims

Reference No: 5851

Location:

East London, Eastern Cape, ZA

Employment Type: Fixed Term Contract

Disability (EE targeted role): No

T.A.S.K Grade: 10

Job Posting Salary: R434,656.00

Job Posting End Date: 12 Aug 2025

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 24-month, fixed-term contract position

Purpose of the job: The Consultant: Merits is responsible for the assessment of merits to determine RAF liability as well as obtain information from various stakeholders in order to assess the merits for claims.

Key Performance Areas

Merits management

• Compare the data on the accident information Centre against the claim to determine RAF liability.
• Categorize merits assessment using RAF defined merits classification (driver/non driver).
• Thoroughly investigate the merits of a claim/assessment of the merits file.
• Apply merits scenarios and rules to determine merits outcomes.
• Complete all necessary checklists and apply application categorization rules.
• Determine the need for a referral to claims investigation unit for further investigation and analyze the outcomes
• Record merits outcome and generate the offer.
• Submit the offer-to-offer management for further communication to the claimant.
  
  

Quality assurance

• Quality assures the outcomes of liability determination and captures the reasons for disagreement.
• Ensure that merits processes are implemented and maintained to the highest standards.
• Maintain the implementation of an unusual occurrence procedure.
  
  

Administrative support

• Verify registered merits information against Accident data Centre.
• 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 resolve all queries, following up and making recommendations on which corrective actions are appropriate.
• Follow up and feedback to all stakeholders to keep them updated on the status of a query.
  
  

Qualifications

• Bachelor’s Degree/ Advanced Diploma in a Health Sciences or Law related qualification.
  
  

Experience

• Relevant 3 years’ experience in an insurance/ investigations/ claims related environment.
  
  

Technical And Behavioral Competencies Required

• Understanding of post claim management and settlement.
• Medical bill reviewing.
• Medical case management.
• 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.
• Knowledge of budgeting, sales, business development, and strategic planning.
• Planning, Organizing and Coordinating
• Personal Mastery
• Judgement and Decision Making
• Ethics and Values
• Client Service Orientation
  
  

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.