Release 

Comments 

Release 1

This version first released with FNS Financial Services Training Package Version 6.0.

ELEMENT 

PERFORMANCE CRITERIA 

Elements describe the essential outcomes.

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

1. Determine validity of claim

1.1 Gather information and review validity of claim according to organisational policies and procedures, and legislative and regulatory requirements

1.2 Return invalid claims and information to claimant for correction as required

1.3 Enter claim information into claims management system according to organisational policies and procedures and codes of practice

1.4 Refer claim to appropriate risk assessment area according to organisation delegation of authority procedures

2. Assess and manage risks

2.1 Identify and assess risks of the claim based on information collected during the claim registration process

2.2 Manage identified risks according to organisational policies and procedures

2.3 Escalate claim as required according to organisational policies and procedures

3. Assess claim for acceptance or rejection based on organisational policies and legislative requirements

3.1 Conduct investigations to determine initial liability and obtain appropriate medical and factual evidence

3.2 Assess evidence and information provided by the client and other required parties

3.3 Identify fraud indicators and escalate according to organisational policies or procedures, or legal requirements

3.4 Accept, deny or hold pending appropriate legal action according to legislative requirements, organisational policies or procedures

4. Determine entitlements and conduct claim management actions

4.1 Determine compensation entitlement amounts according to legislative and organisational policies and procedures

4.2 Plan and implement claim management strategies in consultation with stakeholders

4.3 Document referral process and seek stakeholder confirmation as required

4.4 Record stakeholder interaction and agree on actions according to organisational policies and procedures, and legislative and regulatory requirements

4.5 Identify and document contingency and corrective action plans

4.6 Determine medical liability in consultation with required stakeholders

4.7 Prepare case for conference according to organisational policies and procedures

4.8 Conduct conference and undertake agreed actions

S KILL 

DESCRIPTION 

Oral communication

• Participates in verbal exchanges with a range of personnel
• Uses active listening and questioning techniques to determine, clarify and confirm information

Reading

• Compares and interprets information from a variety of sources to determine requirements

Writing

• Records key enquiry information and prepares documentation using clear language, including appropriate terminology, spelling and grammar

Problem solving

• Uses systematic, analytical problem-solving processes in complex, routine and non-routine situations, gathering information and identifying and evaluating options against agreed criteria

Self-management

• Identifies and follows legislative and regulatory requirements, referral and delegation procedures, organisational policies and procedures
• Takes steps to source information in order to develop knowledge and understanding of work role

Teamwork

• Uses collaborative techniques to liaise with others and elicit and share information

Technology

• Uses the main features and functions of digital tools to complete work tasks

Release 

Comments 

Release 1

This version first released with FNS Financial Services Training Package Version 6.0.