This unit applies to job roles involving claim payment processing in a range of insurance sectors and may be applied within organisations of various sizes and across a range of customer bases.

ELEMENT

PERFORMANCE CRITERIA

1. Process payments

1.1. Payment information is identified, checked and accurately recorded

1.2. All payments are authorised in accordance with organisation operating procedures

1.3. Payments are generated as directed with reference to legislation, organisation policy and operating procedures and codes of practice, if applicable, within timeframes

1.4. Payment documents are completed identifying relevant details

1.5. Payment limits are observed for amounts requiring personal signing

2. Notify reinsurer, if appropriate

2.1. Reinsurance information related to claims payment is checked

2.2. Where appropriate, reinsurers notified of claim payment amount and details under relevant reinsurance arrangements

3. Finalise claims payment information to facilitate payment

3.1. Where required, payment information is finalised and entered on the system to prompt payment

3.2. Claims payment data and/or payments are dispatched within the required timeframe

3.3. Documents are copied and filed for auditing purposes according to organisation operating procedures

3.4. Interested parties are advised according to operating procedures where liability is not accepted

Required skills

communication skills to:

determine and confirm information, using questioning and active listening as required

relate to customers

liaise with others, share information, listen and understand

use language and concepts appropriate to cultural differences

numeracy and IT skills to:

perform calculations related to achieving required outcomes

use computer applications (word processing, spreadsheet, database, specific purpose computer systems) to assist in achieving required outcomes

access and update records electronically

access web-based information services

literacy skills to read and interpret documentation from a variety of sources and record and consolidate relevant related information

research and analysis skills for accessing and interpreting relevant information

organisational skills, including the ability to plan and sequence work

Required knowledge

basic relevant accounting practice

relevant legislation, regulations organisation operating procedures and codes of practice

relevant taxation law, including Goods and Services Tax (GST) requirements

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:

use detail and accuracy in following relevant legislation and organisation policy.

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 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.

Organisation operating procedures would specify:

authority levels

delegations

filing requirements

organisation accounting systems

other relevant details

payment process

timeframes.

Payment limits will be related to:

the authority limits and will vary from one organisation to another.

Reinsurers notified by:

raising a credit or a debit note.

Systems may be:

computerised, and data recording and updating may be electronic in the majority of cases.

Entering claims payment data may include:

coding according to organisation requirements (entering statistical data).

Documents may be:

hard copies/paper or they may be electronic.

Filing may be:

filing of hard copies or entry and storage in a computer system.

Unit sector

Insurance services

This unit contains employability skills.