Claims Audit Officer (12-Month Contract) – Centurion
Finance / Accounting ~ SHERQ (Safety Health Risk Quality)
Centurion – Gauteng
Claims Audit Officer (24-Month Contract) – Centurion
Salary: up to R434,656.00 pa (Based on experience)
Purpose of the role:
The Officer: Claims Audit is responsible for conducting comprehensive backlog claim audits to determine claim status, verify claimant and system information, identify outstanding information and dependencies and recommend further handling of the file to the correct workstream in line with the findings.
Minimum Requirements and Experience:
- Bachelor’s Degree/Advanced Diploma in:
- Public Administration
- Business Management
- Quality Assurance
- Compliance
- Legal related qualification.
- Relevant 3 years’ Quality Assurance experience in:
- Claims administration related environment.
- Record management experience
- Experience working in the public sector.
- Persons with disabilities (PWD) are encouraged to apply.
Key Performance Areas:
Validation of Merits and liability status:
- Check whether merits have been assessed and record the outcome.
- Check whether merits documentation is available on file.
- Identify outstanding merits documentation required before referral.
- Recommend referral to the Merits and Investigation stream and where merits remain outstanding or require clarification.
Litigation status and stage review:
- Check whether the file has a summons.
- Confirm whether the summons is defended.
- Confirm the State Attorney allocated where available and confirm if the trial date has been set.
- Recommend referral to the litigation stream where litigation remain outstanding or require clarification.
Medical assessment, general damages and HPCSA review:
- Check whether the medical unit has assessed the file.
- Determine whether the seriousness of injuries was assessed.
- Verify whether general damages were offered and settled.
- Confirm whether there is proof of The Company rejecting general damages.
- Confirm whether HPCSA records are maintained on file where applicable.
- Refer the file to medical for further assessment.
Settlement readiness assessment:
- Check whether earnings information has been obtained, including payslips, tax returns and confirmation of highest level of education.
- For minors, check whether school reports are available.
- Confirm whether all expert reports are on file.
- Confirm whether any additional expert reports are required.
- Review and mark the file as ready for actuarial assessment where requirements are met.
NB: Should you not be contacted within 2 weeks of your application, please consider it as unsuccessful.
