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Claims Administration Essentials
Next course starting 4th February 2009
Course overview
ITR have chosen 8 units from the Certificate IV in Government (Injury Claims Administration) that we believe are the essential learning tools for claims administrators. All units are nationally accredited.
PSPGOV422A Apply government processes
Overview of WorkCover, its powers, powers of self insurers and structure and hierarchy of WorkCover
Government legislation impacting on Self Insurers such as Workers Compensation, Privacy, Confidentiality, FOI
Legislative process—including Self Insurance Code of conduct, Natural Consequences Model
Audit Process - requirements understanding the standards
PSPIM401A Conduct initial claim assessments
Initial assessment of claim, including assessing the claimants paperwork and appropriate file management
Powers to investigate a claim
Determining Compensability and if claimant is a worker under the Act
PSPETHC401A - Uphold and support the values and principles of public service
Ethics within the workplace
Application of ethical values and principles within the workplace
Ethical decision making and problem solving
PSPIM408A Monitor and review injury management cases
Assessing Rehabilitation Needs
Monitoring rehabilitation and return to work plans and programs
Understanding and applying Sections 26 and 28A of the Act to ensure appropriate and timely return to work
Applying appropriate statutory reductions and economic reviews of income maintenance
Assessing and finalising Section 43 entitlements and discontinuing income maintenance appropriately
PSPIM403A Make claim determinations
Interim Payments - what are they, and how and when to pay
Investigating the claim - how, and what to do
Appropriate recording of information on the file, including payment of expenses—review of Section 32
PSPIM409A Maintain injury management case files
Setting up files and ensuring their security and confidentiality
File administration, ensuring case files meet the required standards and are managed within necessary timeframes
Actuarial assessments of file and file estimations
Closure of files is achieved in a timely and appropriate manner
Reduction and suspension of payments
PSPREG410B Give evidence
Understanding the legal process in workers compensation
Preparing to give evidence
Understanding the documentation requirements for the Workers Compensation Tribunal
Role of a self insurer in Tribunal proceedings
BSBMED301A Use advance medical terminology
Knowledge of medical terminology, specialists and commonly occurring injuries and illnesses
Interpreting PMC’s, Medical Reports and written and oral instructions from medical personnel
Seeking appropriate medical advice
Writing appropriate medical report requests
Duration: 8 days; 9.30 – 4.30
PSP40804
Certificate IV in Government (Injury Claims Administration)
Course overview
This qualification covers the competencies required of injury claims administrators in the public sector. Throughout this course there is an emphasis on improving the service to South Australian workers and employers by ensuring injured workers receive the assistance they need to return to work as early as possible in the process.
Content
PSPGOV422A
Apply government processes
Overview of WorkCover, its powers, powers of self insurers and structure and hierarchy of WorkCover
Government legislation impacting on Self Insurers such as Workers Compensation, Privacy, Confidentiality, FOI
Legislative process—including Self Insurance Code of conduct, Natural Consequences Model
Audit Process - requirements understanding the standards
PSPIM401A
Conduct initial claim assessments
Initial assessment of claim, including assessing the claimants paperwork and appropriate file management
Powers to investigate a claim
Determining Compensability and if claimant is a worker under the Act
PSPETHC401A
Uphold and support the values and principles of public service
Ethics within the workplace
Application of ethical values and principles within the workplace
Ethical decision making and problem solving
PSPIM408A
Monitor and review injury management cases
Assessing Rehabilitation Needs
Monitoring rehabilitation and return to work plans and programs
Understanding and applying Sections 26 and 28A of the Act to ensure appropriate and timely return to work
Applying appropriate statutory reductions and economic reviews of income maintenance
Assessing and finalising Section 43 entitlements and discontinuing income maintenance appropriately
PSPIM403A
Make claim determinations
Interim Payments - what are they, and how and when to pay
Investigating the claim - how, and what to do
Appropriate recording of information on the file, including payment of expenses—review of Section 32
PSPIM409A
Maintain injury management case files
Setting up files and ensuring their security and confidentiality
File administration
Ensuring case files meet the required standards and are managed within necessary timeframes
Actuarial assessments of file and file estimations
Closure of files is achieved in a timely and appropriate manner
Reduction and suspension of payments
PSPREG410B
Give evidence
Understanding the legal process in workers compensation
Preparing to give evidence
Understanding the documentation requirements for the Workers Compensation Tribunal
Role of a self insurer in Tribunal proceedings
BSBMED301A
Use advance medical terminology
Knowledge of medical terminology, specialists and commonly occurring injuries and illnesses
Interpreting PMC’s, Medical Reports and written and oral instructions from medical personnel
Seeking appropriate medical advice
Writing appropriate medical report requests
PSPGOV402B
Deliver and monitor service to clients
Defining the specific needs of the client—evaluating the ‘whole’ person and their needs
Tailoring communication to the clients needs
Seeing workers and their managers as internal customers and managing their needs in line with this.
Establishing accountability with all clients involved in the return to work process
PSPGOV412A
Use advanced workplace communication strategies
Establishing a rapport with the claimant
Questioning, listening and enquiring skills
Conflict Resolution and giving directions in a clear and concise manner
Presentation of information at case conference including how to facilitate a meeting for a successful outcome
PSPGOV408A
Value diversity
Understanding what diversity means and how to obtain relevant information
Assessing and managing diversity within the workplace
Assessing NESB, language and literacy issues and implementing appropriate management programs
Developing appropriate communication methods to meet the needs of the diverse workplace
PSPGOV516A
Develop and use emotional intelligence (Diploma level)
What is Emotional Intelligence? Encouraging its development within the workplace
How emotional intelligence can be utilised in the workplace to ensure better return to work outcomes
Developing flexibility and adaptability to deal better with others
Promoting a positive emotional climate in the workplace
PSPPOL404A
Support policy implementation
Understanding the government policies that impact on claims management within the self insurance environment
Determining how to ensure you continue to comply with relevant policy
Ensuring self insurance policies and procedures comply with statutory requirements.
BSBCMN421A
Assist with compliance with OHS and other relevant laws
Current OHS legislation—Act, Regulations, Codes of practice and standards—how do they fit together?
Responsibilities of all parties under the OHS Act—importance of OHS to a self insurer
Advise on relevant OHS to personnel involved in the claim
Ensuring any return to work does not put the worker at risk of aggravation
PSPLEGN401A
Encourage compliance with legislation in the public sector
Knowledge of the range of legislation that applies to self insurers
Understanding the integration of the relevant legislation
Consequences of non compliance with legislation
Duration: 14 days; 9.30-4.30
Injury Claims Administration Units - ½ day
Title: Ethics in the workplace
Ethics within the workplace
Application of ethical values and principles within the workplace
Ethical decision making and problem solving
PSPETHC401A Uphold and support the values and principles of public service
Title: Monitor and review injury management cases
Assessing Rehabilitation Needs
Monitoring rehabilitation and return to work plans and programs
Understanding and applying Sections 26 and 28A of the Act to ensure appropriate and timely return to work
Applying appropriate statutory reductions and economic reviews of income maintenance
Assessing and finalising Section 43 entitlements and discontinuing income maintenance appropriately
PSPIM408A Monitor and review injury management cases
Injury Claims Administration Units - 1 day
Title: Apply government processes
Overview of WorkCover, its powers, powers of self insurers and structure and hierarchy of WorkCover
Government legislation impacting on Self Insurers such as Workers Compensation, Privacy, Confidentiality, FOI
Legislative process—including Self Insurance Code of conduct, Natural Consequences Model
Audit Process - requirements understanding the standards
PSPGOV422A Apply government processes
Title: Claim determinations
Interim Payments - what are they, and how and when to pay
Investigating the claim - how, and what to do
Appropriate recording of information on the file, including payment of expenses—review of Section 32
PSPIM403A Make claim determinations
Title: Maintain injury management case files
Setting up files and ensuring their security and confidentiality
File administration
Ensuring case files meet the required standards and are managed within necessary timeframes
Actuarial assessments of file and file estimations
Closure of files is achieved in a timely and appropriate manner
Reduction and suspension of payments
PSPIM409A Maintain injury management case files
Title: Giving evidence
Understanding the legal process in workers compensation
Preparing to give evidence
Understanding the documentation requirements for the Workers Compensation Tribunal
Role of a self insurer in Tribunal proceedings
PSPREG410B Give evidence
Injury Claims Administration Units - 1 day
Title: Medical terminology
Knowledge of medical terminology, specialists and commonly occurring injuries and illnesses
Interpreting PMC’s, Medical Reports and written and oral instructions from medical personnel
Seeking appropriate medical advice
Writing appropriate medical report requests
BSBMED301A Use advance medical terminology
Title: Deliver and monitor service to clients
Defining the specific needs of the client—evaluating the ‘whole’ person and their needs
Tailoring communication to the clients needs
Seeing workers and their managers as internal customers and managing their needs in line with this.
Establishing accountability with all clients involved in the return to work process
PSPGOV402B Deliver and monitor service to clients
Title: Workplace communication strategies
Establishing a rapport with the claimant
Questioning, listening and enquiring skills
Conflict Resolution and giving directions in a clear and concise manner
Presentation of information at case conference including how to facilitate a meeting for a successful outcome
PSPGOV412A Use advanced workplace communication strategies
Title: Diversity
Understanding what diversity means and how to obtain relevant information
Assessing and managing diversity within the workplace
Assessing NESB, language and literacy issues and implementing appropriate management programs
Developing appropriate communication methods to meet the needs of the diverse workplace
PSPGOV408A Value diversity
Title: Emotional intelligence
What is Emotional Intelligence? Encouraging its development within the workplace
How emotional intelligence can be utilised in the workplace to ensure better return to work outcomes
Developing flexibility and adaptability to deal better with others
Promoting a positive emotional climate in the workplace
PSPGOV516A Develop and use emotional intelligence (Diploma level)
Title: Policy implementation
Understanding the government policies that impact on claims management within the self insurance environment. Determining how to ensure you continue to comply with relevant policy
Ensuring self insurance policies and procedures comply with statutory requirements.
PSPPOL404A Support policy implementation
Injury Claims Administration Units - 1 day
Title: OHS and other relevant laws
Current OHS legislation—Act, Regulations, Codes of practice and standards—how do they fit together?
Responsibilities of all parties under the OHS Act—importance of OHS to a self insurer
Advise on relevant OHS to personnel involved in the claim
Ensuring any return to work does not put the worker at risk of aggravation
BSBCMN421A Assist with compliance with OHS and other relevant laws
Title: Compliance with legislation in the public sector
Knowledge of the range of legislation that applies to self insurers
Understanding the integration of the relevant legislation
Consequences of non compliance with legislation
PSPLEGN401A Encourage compliance with legislation in the public sector
Title: Medical terminology
BSBMED301A Use advance medical terminology
Knowledge of medical terminology, specialists and commonly occurring injuries and illnesses
Interpreting PMC’s, Medical Reports and written and oral instructions from medical personnel
Seeking appropriate medical advice
Writing appropriate medical report requests
Injury Claims Administration Units - 2 day
Title: Conduct initial claim assessments
Initial assessment of claim, including assessing the claimants paperwork and appropriate file management
Powers to investigate a claim
Determining Compensability and if claimant is a worker under the Act
PSPIM401A Conduct initial claim assessments
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