Unit of competency Outline
Date retreived
22/07/2026 10:06 PM AWST
22/07/2026 10:06 PM AWST
Whilst all efforts are made to provide accurate and timely information from the relevant source/documentation, please be aware that the information supplied may not be the most current version. The accuracy of the detail has not been confirmed by the Department and therefore should not be relied upon without first confirming the contents.
Manage claims
Manage claims
Unit of competency
National Code
FNSPIM304A
FNSPIM304A
State Code
D4277
D4277
TGA Status
Replaced
Replaced
DTWD Status
Replaced
Replaced
State Implementation and Classification
Approved Date
29/07/2014
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
29/07/2014
Nominal Hours
60
Description
This unit describes the performance outcomes, skills and knowledge required to manage personal injury claims from receipt of claim to closure. It encompasses assessing and determining claim liability, identifying potential fraud indicators and facilitating interaction with stakeholders to determine the outcome of a claim.This unit may apply to job roles subject to licensing, legislative, regulatory or certification requirements so Commonwealth, State or Territory requirements should be confirmed with the relevant body.
Notes
Elements and Performance Criteria
1. Assess claim and determine liability
- 1.1. Gather claiminformation in accordance with organisation guidelines and legislative requirements
- 1.2. Review validity of claim in accordance with organisation and legislative requirements
- 1.3. Return invalid claims or information to claimant for correction
- 1.4. Enter claims into organisation claims management system in accordance with organisation guidelines and codes of practice and time requirements
- 1.5. Refer claim to appropriate risk assessment area in accordance with organisation delegation authorities
2. Identify potential risk indicators
- 2.1. Highlight and identify areas of risk within claim including fraudulent and inappropriate behaviour
- 2.2. Use information collected during the claims registration process to assess the risk of the claim
- 2.3. Follow organisation tools and procedures for the management of risk and identify potential risk areas that may lead to escalation
- 2.4. Follow organisation procedures for escalation
3. Facilitate interaction and consult with stakeholders
- 3.1. Plan and implement strategies in accordance with stakeholders
- 3.2. Document referral process with stakeholders' involvement
- 3.3. Record stakeholder interaction in accordance with legislative and organisation standards
- 3.4. Record agreed actions and undertakings as outlined by stakeholders
- 3.5. Identify and document contingency and corrective action plans
- 3.6. Determine medical liability in consultation with stakeholders and related parties
- 3.7. Prepare case for conference in accordance with organisation guidelines
- 3.8. Undertake agreed actions as a result of conferencing
RANGE STATEMENT
The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.
Claim information may include:
claim form
consultation with the injured person
consultation with relevant parties
dates covered on medical certificates.
Organisation guidelines and codes of practice may include:
agency of injury
bodily location of injury
claim category (e.g. medical only or temporary disability)
mechanism of injury
nature of injury
occupation of injured person.
Fraudulent and inappropriate behaviour may be from:
the injured person
service providers.
Stakeholders may include:
case managers
community groups
employers
health management specialist
injury management adviser
investigation specialist
legal panel
social rehabilitation specialists
technical manger
vocational rehabilitation specialists.
Related parties may include:
the employer
the family of the injured person.
The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.
Claim information may include:
claim form
consultation with the injured person
consultation with relevant parties
dates covered on medical certificates.
Organisation guidelines and codes of practice may include:
agency of injury
bodily location of injury
claim category (e.g. medical only or temporary disability)
mechanism of injury
nature of injury
occupation of injured person.
Fraudulent and inappropriate behaviour may be from:
the injured person
service providers.
Stakeholders may include:
case managers
community groups
employers
health management specialist
injury management adviser
investigation specialist
legal panel
social rehabilitation specialists
technical manger
vocational rehabilitation specialists.
Related parties may include:
the employer
the family of the injured person.
EVIDENCE GUIDE
The Evidence Guide provides advice on assessment and must be read in conjunction with the performance criteria, required skills and knowledge, range statement and the Assessment Guidelines for the Training Package.
Overview of assessment
Critical aspects for assessment and evidence required to demonstrate competency in this unit
Evidence of the ability to:
collect accurate information during the claims registration process, in particular the return to work (RTW), return to health status of the claim and the nature of the injury
assess claims and determine entitlements and identify any fraud indicators within claim applications
facilitate interaction with relevant stakeholders, demonstrating knowledge of organisation claims processing requirements
interpret and apply relevant legislative requirements regarding claim processing.
Context of and specific resources for assessment
Assessment must ensure:
competency is demonstrated in the context of the work environment and conditions specified in the range statement either in a relevant workplace or a closely simulated work environment
access to and the use of a range of common office equipment, technology, software and consumables
access to organisation records
access to organisation policies and procedures.
Method of assessment
A range of assessment methods should be used to assess practical skills and knowledge. The following examples, in combination, are appropriate for this unit:
evaluating an integrated activity, which combines the elements of competency for the unit, or a cluster of related units of competency
observing processes and procedures in workplaces
verbal or written questioning on underpinning knowledge and skills
evaluating samples of work
accessing and validating third party reports.
Guidance information for assessment
The Evidence Guide provides advice on assessment and must be read in conjunction with the performance criteria, required skills and knowledge, range statement and the Assessment Guidelines for the Training Package.
Overview of assessment
Critical aspects for assessment and evidence required to demonstrate competency in this unit
Evidence of the ability to:
collect accurate information during the claims registration process, in particular the return to work (RTW), return to health status of the claim and the nature of the injury
assess claims and determine entitlements and identify any fraud indicators within claim applications
facilitate interaction with relevant stakeholders, demonstrating knowledge of organisation claims processing requirements
interpret and apply relevant legislative requirements regarding claim processing.
Context of and specific resources for assessment
Assessment must ensure:
competency is demonstrated in the context of the work environment and conditions specified in the range statement either in a relevant workplace or a closely simulated work environment
access to and the use of a range of common office equipment, technology, software and consumables
access to organisation records
access to organisation policies and procedures.
Method of assessment
A range of assessment methods should be used to assess practical skills and knowledge. The following examples, in combination, are appropriate for this unit:
evaluating an integrated activity, which combines the elements of competency for the unit, or a cluster of related units of competency
observing processes and procedures in workplaces
verbal or written questioning on underpinning knowledge and skills
evaluating samples of work
accessing and validating third party reports.
Guidance information for assessment
Replaced By
| State Code | National Code | Title | Type |
|---|---|---|---|
| AUS49 | FNSPIM304 | Assess and determine ongoing entitlements | Unit of competency |
| State Code | National Code | Title | Type |
|---|---|---|---|
| S702 | FNS40310 | Certificate IV in Personal Injury Management (Claims Management) | Qualification |
| S694 | FNS30210 | Certificate III in Personal Injury Management (ClaimsManagement) | Qualification |