Elements and Performance Criteria

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.
Claims checking involves:
manual checklists or through data entry validation on computer systems and may include:
previous payment to claimant
claim has been sent to the wrong insurer
liability has not been accepted.
Entering claims data may include:
coding according to organisation requirements (entering statistical data).
Registering claims may involve:
entering claims reserve/estimate
identifying interested parties
identifying reinsurance involvement
linking to relative policy
observing limits to authority level
recording in system.
Organisation procedures may include:
correspondence presentation
initiation of new claims and processing of claims
security procedures.
Authorities may include:
a written policy and procedures manuals that define the level of authority to make decisions on claims within the organisation
guidelines/procedures relating to injury management and use of service providers.
Systems may be:
computerised, with record updating by electronic or manual data recording.
Service providers may include
accountants
assessors
auditors
engineers
investigators
medical advisers
private investigators
surveyors
others as required.
If reinsurance is identified:
check specific treaty and/or facultative coverage for catastrophic claims and allocate internal category code.
Reinsurance advice may include:
notifying the reinsurer of potential claim (if appropriate) by raising a credit/debit note.
Legislative and organisational requirements may include:
Health and Other Services (Compensation) Act
industrial relations legislation
Privacy Act
social security legislation
State and Territory workers compensation Acts and regulations
taxation legislation.

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:
fully comply with organisation operating procedures, legislative requirements and industry codes of practice
use accuracy and attention to detail and thorough checking of data.

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