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Evidence Guide: PSPIM301A - Process claims

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

 

PSPIM301A - Process claims

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

Confirm details

  1. Documents are completed, and authorisation/s are obtained for claims in accordance with legislation, organisational policy and procedures.
  2. Reasonableness of accounts is assessed to ensure accounts that are paid are relevant to disability.
  3. Account details are recorded in accordance with system and organisational requirements.
  4. When accounts are rejected notifications are made in accordance with legislation, organisational policy and procedures.
Documents are completed, and authorisation/s are obtained for claims in accordance with legislation, organisational policy and procedures.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Reasonableness of accounts is assessed to ensure accounts that are paid are relevant to disability.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Account details are recorded in accordance with system and organisational requirements.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

When accounts are rejected notifications are made in accordance with legislation, organisational policy and procedures.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Process payments

  1. Cheque production and posting or electronic transfer of funds is effected in accordance with organisational procedures.
  2. Accounts are batched where required for traceability.
  3. Authorisations for periodic payments are confirmed to avoid overpayments.
  4. Claims are processed within time limits to comply with legislation, policy and key performance indicators.
Cheque production and posting or electronic transfer of funds is effected in accordance with organisational procedures.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Accounts are batched where required for traceability.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Authorisations for periodic payments are confirmed to avoid overpayments.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Claims are processed within time limits to comply with legislation, policy and key performance indicators.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Maintain files

  1. Records are maintained in accordance with legislation and the organisation's recordkeeping requirements.
  2. Documentation of all contacts relating to processing of claims is completed in accordance with organisational policy and procedures.
  3. Evidence of file management is maintained for audit purposes.
Records are maintained in accordance with legislation and the organisation's recordkeeping requirements.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Documentation of all contacts relating to processing of claims is completed in accordance with organisational policy and procedures.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Evidence of file management is maintained for audit purposes.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

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

Required Skills and Knowledge

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

Range Statement

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)