Job title : Officer : Undertakings x4 - Menlo Park, Gauteng, ZA
Job Location : Gauteng,
Deadline : October 30, 2025
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Key Performance Areas
Handle Claims
Interpret the settlement, the undertaking and any limitations to determine the Funds liability for future costs to be incurredScrutinize past medical expenses to determine the Funds liability for future costs to be incurred.Identify any differences between the final settlement and re-draft the undertaking to reflect the correct liabilityTake cognisance of all expert reports, of internal and external origin, to determine the following :
The nexus between the costs incurred and the accident.The reasonability of the costs by comparing the costs incurred with the claimants personal circumstances and needsCommunicate with experts where there is uncertainty i.r.o. costs incurred.Report any discrepancies to SeniorPre-authorise costs still to be incurred in terms of the undertaking within the mandate and in line with the medical and legal assessmentRecommend or approve payment of the costs as per the mandate; or repudiate the costs; or request more information or refer for medical intervention.Refer cases to field Case Managers for further investigation.Determine the need for home visits and attend when required.Determine the need for the appointment of experts to do further assessments.Approve other officers payments on MIS which includes checking for duplicates and if the correct payee is being paid.Update Claims Records
Correct / update any change in the settlement details on the undertaking system to ensure that the liability of the Fund is accurately reflected on the system.Manage Correspondence
Draft legal correspondence to all external stakeholders.Attend to Queries
Attend to queries from internal and external stakeholders pertaining to the undertaking including the following :Liability of the Fund in terms of the undertaking.How to submit a claim;Status / progress made on the claims already submittedGeneral enquiriesGive advice to stakeholders on legal issues pertaining to undertakingsManage Litigation
Receive & record all litigation processes served in terms of the UndertakingEvaluate the documents, consider the Funds legal position with regards to the processArrange for the matter to be held over, if necessary, alternativelyAppoint an attorney for the Fund to defend the matter.Refer the matter for assessment to determine the Funds liability.Negotiate settlement with the attorney, alternatively, consider the opinions from the attorney and give clear instruction to the Funds attorneys to reach settlementAdhere to the time limits to prevent any wasted costsAttend to opinions from attorneys to ensure that the Fund is ready for trial when due.Report any risk to the Senior to prevent any prejudice to the FundArrange for interim disbursements to be attended to appropriately at Legal costs.Give proper instructions for settlement payments or payments in terms of court orders to prevent any unnecessary interest to be added.Arrange for the bill for costs to be referred to Legal costs to attend to and follow up on payment thereof.Report any actions from the Funds attorneys which is not in line with the Funds policies to the Senior.Compile Statistics
Keep daily stats of activities on Undertakings and related matters.Submit daily stats and monthly stats as required by Management.Keep record of statistics.Keep Claims Records
Maintain record of all allocated mattersMaintain record of litigated mattersMaintain and apply a diary system used to pend matters to be followed upScrutinize incoming correspondence and maintain proper record thereofMaintain proper record of files requested and returned to the I / S, referred to Medical and / or Administration cellKeep record of private telephone calls and submit accurate telephone accounts on a monthly basis.Qualifications & Experience
NQF 7(Bachelor’s Degree OR Advanced Diploma) related qualification to discipline.Relevant 3 years’ experience in the claims environment.Insurance jobs