Elements and Performance Criteria
- Assess claim and determine liability
- Gather claiminformation in accordance with organisation guidelines and legislative requirements
- Review validity of claim in accordance with organisation and legislative requirements
- Return invalid claims or information to claimant for correction
- Enter claims into organisation claims management system in accordance with organisation guidelines and codes of practice and time requirements
- Refer claim to appropriate risk assessment area in accordance with organisation delegation authorities
- Identify potential risk indicators
- Highlight and identify areas of risk within claim including fraudulent and inappropriate behaviour
- Use information collected during the claims registration process to assess the risk of the claim
- Follow organisation tools and procedures for the management of risk and identify potential risk areas that may lead to escalation
- Follow organisation procedures for escalation
- Facilitate interaction and consult with stakeholders
- Plan and implement strategies in accordance with stakeholders
- Document referral process with stakeholders' involvement
- Record stakeholder interaction in accordance with legislative and organisation standards
- Record agreed actions and undertakings as outlined by stakeholders
- Identify and document contingency and corrective action plans
- Determine medical liability in consultation with stakeholders and related parties
- Prepare case for conference in accordance with organisation guidelines
- Undertake agreed actions as a result of conferencing