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Evidence Guide: FNSPIM302 - Determine claim liability

Student: __________________________________________________

Signature: _________________________________________________

Tips for gathering evidence to demonstrate your skills

The important thing to remember when gathering evidence is that the more evidence the better - that is, the more evidence you gather to demonstrate your skills, the more confident an assessor can be that you have learned the skills not just at one point in time, but are continuing to apply and develop those skills (as opposed to just learning for the test!). Furthermore, one piece of evidence that you collect will not usualy demonstrate all the required criteria for a unit of competency, whereas multiple overlapping pieces of evidence will usually do the trick!

From the Wiki University

 

FNSPIM302 - Determine claim liability

What evidence can you provide to prove your understanding of each of the following citeria?

Receive and clarify claim information

  1. Enter claim information into relevant organisational systems
  2. Process claim in accordance with required timeframes and according to relevant Acts, regulations and organisational procedures
  3. Complete correspondence in accordance with organisational policy and procedures, and allocate to relevant claims personnel
  4. Advise clients of organisational claims procedures and respond to queries in an appropriate manner
  5. Check claim information for accuracy and validity in accordance with organisational policy and procedures
Enter claim information into relevant organisational systems

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Process claim in accordance with required timeframes and according to relevant Acts, regulations and organisational procedures

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Complete correspondence in accordance with organisational policy and procedures, and allocate to relevant claims personnel

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Advise clients of organisational claims procedures and respond to queries in an appropriate manner

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Check claim information for accuracy and validity in accordance with organisational policy and procedures

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Determine status of claim

  1. Analyse all information against regulatory requirements and organisational guidelines to determine liability
  2. Refer claims to internal or external specialists where required and in accordance with organisational guidelines
Analyse all information against regulatory requirements and organisational guidelines to determine liability

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Refer claims to internal or external specialists where required and in accordance with organisational guidelines

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Accept or reject claim

  1. Determine liability decision in accordance with organisational guidelines, regulatory requirements, industry codes of practice and defined timeframes
  2. Adhere to referral procedures where claim amounts are outside settlement and/or claims management authority
  3. Determine decision on liability, considering review and feedback from external stakeholders
Determine liability decision in accordance with organisational guidelines, regulatory requirements, industry codes of practice and defined timeframes

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Adhere to referral procedures where claim amounts are outside settlement and/or claims management authority

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Determine decision on liability, considering review and feedback from external stakeholders

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Document liability decision

  1. Communicate liability decisions to relevant stakeholders in accordance with regulatory requirements, operating procedures and relevant codes of practice
  2. Communicate reasons for decisions promptly to clients and other relevant stakeholders
  3. Document decisions and file to demonstrate basis on which claim decision was determined, including all evidence and information that was considered, where appropriate
Communicate liability decisions to relevant stakeholders in accordance with regulatory requirements, operating procedures and relevant codes of practice

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Communicate reasons for decisions promptly to clients and other relevant stakeholders

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Document decisions and file to demonstrate basis on which claim decision was determined, including all evidence and information that was considered, where appropriate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Receive and clarify claim information

1.1 Enter claim information into relevant organisational systems

1.2 Process claim in accordance with required timeframes and according to relevant Acts, regulations and organisational procedures

1.3 Complete correspondence in accordance with organisational policy and procedures, and allocate to relevant claims personnel

1.4 Advise clients of organisational claims procedures and respond to queries in an appropriate manner

1.5 Check claim information for accuracy and validity in accordance with organisational policy and procedures

2. Determine status of claim

2.1 Analyse all information against regulatory requirements and organisational guidelines to determine liability

2.2 Refer claims to internal or external specialists where required and in accordance with organisational guidelines

3. Accept or reject claim

3.1 Determine liability decision in accordance with organisational guidelines, regulatory requirements, industry codes of practice and defined timeframes

3.2 Adhere to referral procedures where claim amounts are outside settlement and/or claims management authority

3.3 Determine decision on liability, considering review and feedback from external stakeholders

4. Document liability decision

4.1 Communicate liability decisions to relevant stakeholders in accordance with regulatory requirements, operating procedures and relevant codes of practice

4.2 Communicate reasons for decisions promptly to clients and other relevant stakeholders

4.3 Document decisions and file to demonstrate basis on which claim decision was determined, including all evidence and information that was considered, where appropriate

Required Skills and Knowledge

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Receive and clarify claim information

1.1 Enter claim information into relevant organisational systems

1.2 Process claim in accordance with required timeframes and according to relevant Acts, regulations and organisational procedures

1.3 Complete correspondence in accordance with organisational policy and procedures, and allocate to relevant claims personnel

1.4 Advise clients of organisational claims procedures and respond to queries in an appropriate manner

1.5 Check claim information for accuracy and validity in accordance with organisational policy and procedures

2. Determine status of claim

2.1 Analyse all information against regulatory requirements and organisational guidelines to determine liability

2.2 Refer claims to internal or external specialists where required and in accordance with organisational guidelines

3. Accept or reject claim

3.1 Determine liability decision in accordance with organisational guidelines, regulatory requirements, industry codes of practice and defined timeframes

3.2 Adhere to referral procedures where claim amounts are outside settlement and/or claims management authority

3.3 Determine decision on liability, considering review and feedback from external stakeholders

4. Document liability decision

4.1 Communicate liability decisions to relevant stakeholders in accordance with regulatory requirements, operating procedures and relevant codes of practice

4.2 Communicate reasons for decisions promptly to clients and other relevant stakeholders

4.3 Document decisions and file to demonstrate basis on which claim decision was determined, including all evidence and information that was considered, where appropriate

Evidence of the ability to:

receive and clarify information and determine the status of a claim using organisational guidelines and regulatory requirements

document liability decision using organisational guidelines, and demonstrating knowledge of relevant Acts and regulations and organisational policies and procedures

analyse information to draw meaningful conclusions and determine correct action.

Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.

To complete the unit requirements safely and effectively, the individual must:

interpret and describe the key features of insurance policies, reports and related documents

describe the key analysis and research methods used to determine claim liability

categorise data into meaningful terms

outline the major steps in claim liability decision-making processes

describe the key features relevant to determining claim liability of:

insurance policies, reports and related documents

organisational claims processing software

organisational operating procedures

relevant workers compensation, personal injury Acts and regulatory requirements.