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Evidence Guide: FNSPIM304 - Assess and determine ongoing entitlements

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

 

FNSPIM304 - Assess and determine ongoing entitlements

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

Assess claim and determine liability

  1. Gather claim information from a range of sources in accordance with organisation guidelines and legislative requirements
  2. Review validity of claim in accordance with organisation and legislative requirements
  3. Return invalid claims or information to claimant for correction
  4. Enter claims into organisation claims management system in accordance with organisation guidelines, codes of practice and time requirements
  5. Refer claim to appropriate risk assessment area in accordance with organisation delegation authorities
Gather claim information from a range of sources in accordance with organisation guidelines and legislative requirements

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Review validity of claim in accordance with organisation and legislative requirements

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Return invalid claims or information to claimant for correction

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Enter claims into organisation claims management system in accordance with organisation guidelines, codes of practice and time requirements

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Refer claim to appropriate risk assessment area in accordance with organisation delegation authorities

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify potential risk indicators

  1. Identify areas of risk within claim from the injured person or the service provider
  2. Use information collected during the claims registration process to assess the risk of the claim
  3. Follow organisational procedures and use appropriate tools to identify and manage risks factors that may escalate
  4. Follow organisation procedures for escalation
Identify areas of risk within claim from the injured person or the service provider

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Use information collected during the claims registration process to assess the risk of the claim

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Follow organisational procedures and use appropriate tools to identify and manage risks factors that may escalate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Follow organisation procedures for escalation

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Facilitate interaction and consult with stakeholders

  1. Plan and implement strategies in consultation with stakeholders
  2. Document referral process with stakeholders’ involvement
  3. Record stakeholder interaction in accordance with legislative and organisation standards
  4. Record agreed actions and undertakings as outlined by stakeholders
  5. Identify and document contingency and corrective action plans
  6. Determine medical liability in consultation with stakeholders and related parties
  7. Prepare case for conference in accordance with organisation guidelines
  8. Undertake agreed actions as a result of conferencing
Plan and implement strategies in consultation with stakeholders

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Document referral process with stakeholders’ involvement

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Record stakeholder interaction in accordance with legislative and organisation standards

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Record agreed actions and undertakings as outlined by stakeholders

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify and document contingency and corrective action plans

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Determine medical liability in consultation with stakeholders and related parties

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Prepare case for conference in accordance with organisation guidelines

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Undertake agreed actions as a result of conferencing

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. Assess claim and determine liability

1.1 Gather claim information from a range of sources in accordance with organisation guidelines and legislative requirements

1.2 Review validity of claim in accordance with organisation and legislative requirements

1.3 Return invalid claims or information to claimant for correction

1.4 Enter claims into organisation claims management system in accordance with organisation guidelines, codes of practice and time requirements

1.5 Refer claim to appropriate risk assessment area in accordance with organisation delegation authorities

2. Identify potential risk indicators

2.1 Identify areas of risk within claim from the injured person or the service provider

2.2 Use information collected during the claims registration process to assess the risk of the claim

2.3 Follow organisational procedures and use appropriate tools to identify and manage risks factors that may escalate

2.4 Follow organisation procedures for escalation

3. Facilitate interaction and consult with stakeholders

3.1 Plan and implement strategies in consultation with stakeholders

3.2 Document referral process with stakeholders’ involvement

3.3 Record stakeholder interaction in accordance with legislative and organisation standards

3.4 Record agreed actions and undertakings as outlined by stakeholders

3.5 Identify and document contingency and corrective action plans

3.6 Determine medical liability in consultation with stakeholders and related parties

3.7 Prepare case for conference in accordance with organisation guidelines

3.8 Undertake agreed actions as a result of conferencing

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. Assess claim and determine liability

1.1 Gather claim information from a range of sources in accordance with organisation guidelines and legislative requirements

1.2 Review validity of claim in accordance with organisation and legislative requirements

1.3 Return invalid claims or information to claimant for correction

1.4 Enter claims into organisation claims management system in accordance with organisation guidelines, codes of practice and time requirements

1.5 Refer claim to appropriate risk assessment area in accordance with organisation delegation authorities

2. Identify potential risk indicators

2.1 Identify areas of risk within claim from the injured person or the service provider

2.2 Use information collected during the claims registration process to assess the risk of the claim

2.3 Follow organisational procedures and use appropriate tools to identify and manage risks factors that may escalate

2.4 Follow organisation procedures for escalation

3. Facilitate interaction and consult with stakeholders

3.1 Plan and implement strategies in consultation with stakeholders

3.2 Document referral process with stakeholders’ involvement

3.3 Record stakeholder interaction in accordance with legislative and organisation standards

3.4 Record agreed actions and undertakings as outlined by stakeholders

3.5 Identify and document contingency and corrective action plans

3.6 Determine medical liability in consultation with stakeholders and related parties

3.7 Prepare case for conference in accordance with organisation guidelines

3.8 Undertake agreed actions as a result of conferencing

Evidence of the ability to:

collect accurate information during the claims registration process, in particular the return to work (RTW), return to health status of the claim and the nature of the injury

assess claims, determine entitlements and identify any fraud indicators within claim applications

facilitate interaction with relevant stakeholders, demonstrating knowledge of organisational claims processing requirements

interpret and apply relevant legislative requirements regarding claims processing.

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:

explain the operations of organisational claims management information technology systems

describe the key features of organisational policy and procedures as they relate to the capture, processing and management of personal injury claims

identify a range of potential risk and fraud indicators relevant to personal injury claims

describe the key features of relevant personal injury legislation

identify and describe the key roles of relevant stakeholder parties within the personal injury sectors to manage personal injury claims effectively.