Claims Audit Officer – 12‑Month Contract

About the role

The Claims Audit Officer will conduct comprehensive backlog claim audits, verify claimant and system information, and identify outstanding dependencies. The role ensures each file is directed to the appropriate workstream based on audit findings.

Key responsibilities

• Validate merits and liability status, record outcomes, and refer files to the Merits and Investigation stream when documentation is incomplete.
• Review litigation status, confirm summons defence, track State Attorney allocation and trial dates, and refer to the litigation stream as needed.
• Assess medical reports, verify seriousness of injuries, confirm general damages offers and rejections, and ensure HPCSA records are maintained.
• Evaluate settlement readiness by gathering earnings information, expert reports, and education verification, then flag files ready for actuarial assessment.

Required profile

• Bachelor’s degree or Advanced Diploma in Public Administration, Business Management, Quality Assurance, Compliance or a related legal field.
• At least 3 years of quality‑assurance experience in a claims‑administration environment.
• Record‑management experience and prior work in the public sector.
• Persons with disabilities are encouraged to apply.