Unit of Competency Mapping – Information for Teachers/Assessors – Information for Learners

PSPIM301A Mapping and Delivery Guide
Process claims

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency PSPIM301A - Process claims
Description This unit covers processing of compensation claims for employment-related injuries in accordance with legislation, organisational policy and procedures. It includes confirming claim details, processing payments and maintaining files.In practice, processing claims may overlap with other generalist or specialist public sector work activities such as acting ethically, complying with legislation, accessing and using resources and financial systems, organising workplace information, etc. No licensing, legislative, regulatory or certification requirements apply to this unit at the time of publication
Employability Skills This unit contains employability skills.
Learning Outcomes and Application Not applicable.
Duration and Setting X weeks, nominally xx hours, delivered in a classroom/online/blended learning setting.
Prerequisites/co-requisites Not applicable.
Competency Field Injury Management.
Development and validation strategy and guide for assessors and learners Student Learning Resources Handouts
Activities 		Slides
PPT 		Assessment 1 Assessment 2 Assessment 3 Assessment 4
Elements of Competency Performance Criteria              
Element: Confirm details
  • Documents are completed, and authorisation/s are obtained for claims in accordance with legislation, organisational policy and procedures.
  • Reasonableness of accounts is assessed to ensure accounts that are paid are relevant to disability.
  • Account details are recorded in accordance with system and organisational requirements.
  • When accounts are rejected notifications are made in accordance with legislation, organisational policy and procedures.
       
Element: Process payments
  • Cheque production and posting or electronic transfer of funds is effected in accordance with organisational procedures.
  • Accounts are batched where required for traceability.
  • Authorisations for periodic payments are confirmed to avoid overpayments.
  • Claims are processed within time limits to comply with legislation, policy and key performance indicators.
       
Element: Maintain files
  • Records are maintained in accordance with legislation and the organisation's recordkeeping requirements.
  • Documentation of all contacts relating to processing of claims is completed in accordance with organisational policy and procedures.
  • Evidence of file management is maintained for audit purposes.
       


Evidence Required

List the assessment methods to be used and the context and resources required for assessment. Copy and paste the relevant sections from the evidence guide below and then re-write these in plain English.

The Evidence Guide specifies the evidence required to demonstrate achievement in the unit of competency as a whole. It must be read in conjunction with the Unit descriptor, Performance Criteria, the Range Statement and the Assessment Guidelines for the Public Sector Training Package.

Units to be assessed together

Pre-requisite units that must be achieved prior to this unit:Nil

Co-requisite units that must be assessed with this unit:Nil

Co-assessed units that may be assessed with this unit to increase the efficiency and realism of the assessment process include, but are not limited to:

PSPETHC301B Uphold the values and principles of public service

PSPGOV301B Work effectively in the organisation

PSPGOV305B Access and use resources and financial systems

PSPGOV307B Organise workplace information

PSPGOV308B Work effectively with diversity

PSPLEGN301B Comply with legislation in the public sector

Overview of evidence requirements

In addition to integrated demonstration of the elements and their related performance criteria, look for evidence that confirms:

the knowledge requirements of this unit

the skill requirements of this unit

application of the Employability Skills as they relate to this unit (see Employability Summaries in Qualifications Framework)

processing of claims in a range of (3 or more) contexts (or occasions, over time)

Resources required to carry out assessment

These resources include:

legislation, policy, procedures and protocols relating to the processing of claims

case studies and workplace scenarios to capture the range of situations likely to be encountered when processing claims

Where and how to assess evidence

Valid assessment of this unit requires:

a workplace environment or one that closely resembles normal work practice and replicates the range of conditions likely to be encountered when processing claims, including coping with difficulties, irregularities and breakdowns in routine

processing of claims in a range of (3 or more) contexts (or occasions, over time)

Assessment methods should reflect workplace demands, such as literacy, and the needs of particular groups, such as:

people with disabilities

people from culturally and linguistically diverse backgrounds

Aboriginal and Torres Strait Islander people

women

young people

older people

people in rural and remote locations

Assessment methods suitable for valid and reliable assessment of this competency may include, but are not limited to, a combination of 2 or more of:

case studies

demonstration

portfolios

questioning

scenarios

simulation or role plays

authenticated evidence from the workplace and/or training courses

For consistency of assessment

Evidence must be gathered over time in a range of contexts to ensure the person can achieve the unit outcome and apply the competency in different situations or environments

Submission Requirements

List each assessment task's title, type (eg project, observation/demonstration, essay, assignment, checklist) and due date here

Assessment task 1: [title]      Due date:

(add new lines for each of the assessment tasks)

Assessment Tasks

Copy and paste from the following data to produce each assessment task. Write these in plain English and spell out how, when and where the task is to be carried out, under what conditions, and what resources are needed. Include guidelines about how well the candidate has to perform a task for it to be judged satisfactory.

This section describes the essential skills and knowledge and their level, required for this unit.

Skill requirements

Look for evidence that confirms skills in:

applying legislation, regulations and policies relating to processing of claims

recording and reporting of transactions

reading and interpreting claims information (literacy level)

checking the accuracy of calculations and reconciliations (numeracy level)

assessing reasonableness of accounts

using communication including reporting of irregularities and errors

responding to diversity, including gender and disability

applying procedures relating to occupational health and safety and environment in the context of claims processing

Knowledge requirements

Look for evidence that confirms knowledge and understanding of:

legislation, regulations, and guidelines relating to injury management

policies and procedures relating to processing of injury claims

privacy legislation

procedures to ensure confidentiality and security of information

procedures for cash and non-cash handling

injury management claims relating to a range of disabilities

methods and techniques for simple numerical calculations

equal employment opportunity, equity and diversity principles

public sector legislation such as occupational health and safety and environment in the context of processing claims

The Range Statement provides information about the context in which the unit of competency is carried out. The variables cater for differences between States and Territories and the Commonwealth, and between organisations and workplaces. They allow for different work requirements, work practices and knowledge. The Range Statement also provides a focus for assessment. It relates to the unit as a whole. Text in bold italics in the Performance Criteria is explained here.

Claims may be:

weekly/fortnightly payments

lump sum payments

medical and other expenses

settlements

redemptions

Legislation, organisational policy and proceduresmay include:

occupational health and safety and injury management legislation

workers rehabilitation/compensation legislation

privacy legislation

freedom of information legislation

procedures to ensure confidentiality and security of information

public sector standards

codes of practice

codes of ethics

Evidence of file managementmay show:

that the direction of claim activity is proactive

that the claim is being managed (not just a matter of processing payments)

Copy and paste from the following performance criteria to create an observation checklist for each task. When you have finished writing your assessment tool every one of these must have been addressed, preferably several times in a variety of contexts. To ensure this occurs download the assessment matrix for the unit; enter each assessment task as a column header and place check marks against each performance criteria that task addresses.

Observation Checklist

Tasks to be observed according to workplace/college/TAFE policy and procedures, relevant legislation and Codes of Practice Yes No Comments/feedback
Documents are completed, and authorisation/s are obtained for claims in accordance with legislation, organisational policy and procedures. 
Reasonableness of accounts is assessed to ensure accounts that are paid are relevant to disability. 
Account details are recorded in accordance with system and organisational requirements. 
When accounts are rejected notifications are made in accordance with legislation, organisational policy and procedures. 
Cheque production and posting or electronic transfer of funds is effected in accordance with organisational procedures. 
Accounts are batched where required for traceability. 
Authorisations for periodic payments are confirmed to avoid overpayments. 
Claims are processed within time limits to comply with legislation, policy and key performance indicators. 
Records are maintained in accordance with legislation and the organisation's recordkeeping requirements. 
Documentation of all contacts relating to processing of claims is completed in accordance with organisational policy and procedures. 
Evidence of file management is maintained for audit purposes. 

Forms

Assessment Cover Sheet

PSPIM301A - Process claims
Assessment task 1: [title]

Student name:

Student ID:

I declare that the assessment tasks submitted for this unit are my own work.

Student signature:

Result: Competent Not yet competent

Feedback to student

 

 

 

 

 

 

 

 

Assessor name:

Signature:

Date:

Assessment Record Sheet

PSPIM301A - Process claims

Student name:

Student ID:

Assessment task 1: [title] Result: Competent Not yet competent

(add lines for each task)

Feedback to student:

 

 

 

 

 

 

 

 

Overall assessment result: Competent Not yet competent

Assessor name:

Signature:

Date:

Student signature:

Date: