Unit of competency details

Unit descriptor 

This unit describes the performance outcomes, skills and knowledge required to generate and process claim related payments. It encompasses ensuring timeframes for payments are met and appropriate records maintained.

This unit is applicable to individuals working within enterprises and job roles subject to licensing, legislative, regulatory or certification requirements including legislation administered by the Australian Securities and Investments Commission (ASIC).

Application of the unit 

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.

Prerequisite units 

Employability skills 

This unit contains employability skills.

Elements describe the essential outcomes of a unit of competency.

Performance criteria describe the performance needed to demonstrate achievement of the element. Where bold italicised text is used, further information is detailed in the required skills and knowledge section and the range statement. Assessment of performance is to be consistent with the evidence guide.

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 AND KNOWLEDGE 

This section describes the skills and knowledge required for this unit.

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

EVIDENCE GUIDE 

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 

RANGE STATEMENT 

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

Competency field 

Co-requisite units