Elements and Performance Criteria
- Receive claim form
- Receive claim form and compile necessary documentation
- Review policy details to ensure valid cover is in force
- Establish that claimant is authorised to deal with policy
- Check that documentation is correct and complete
- Determine authority level required to evaluate claim and refer application to appropriate authority as necessary
- Evaluate claim information
- Identify and review evidence against payment criteria
- Check and confirm whether terms and conditions of policy have been met
- Identify whether policy exclusions apply
- Seek additional specialist advice as appropriate
- Recognise where information suggests unresolved complexity and seek further information as appropriate
- Establish liability for payment
- Determine whether claim can be admitted in accordance with procedures and within authority limits
- Make payment recommendation in accordance with procedures
- Communicate outcomes to all relevant parties in accordance with procedures
- Update records and file documentation in accordance with procedures and regulatory requirements