SayPro Online Course SAQA 11516649356

Description

Associated Assessment Criteria

1.
Current events and developments that could impact on Long-term Insurance are analysed and discussed and a personal point of view is offered in the discussion indicating ability to anticipate or predict future trends.
Knowledge learnt in various Unit Standards and current events as they occur are integrated with a developing understanding of the long-term environment in general, and medical claims assessing in particular, so that knowledge of the industry is applied in authentic situations.
Important areas of Healthcare Benefits Administration are explained with reference to evolution of Medical Scheme Administration in South Africa, managed care and healthcare cover.
Information is gathered, analysed, summarised, and interpreted from a range of sources and presented reliably and accurately. Positions taken are motivated and substantiated.

2.
The basic principles and different forms of individual income tax are explained with reference to an individual’s liability and duty to pay tax.
Basic financial statements are analysed and used to make a personal financial decision.
Financial risk in own life is analysed and ways to reduce own financial risk are investigated for different types of risk.

3.
Methods, procedures and techniques of medical claims assessing are explained with reference to specific company policy, legislative requirements and industry practices.
Information is gathered, analysed, evaluated, interpreted, recorded and presented and decisions are explained within own authority limits or mandate and with due regard for compliance.
The concept of ethics is explained with reference to an organisation’s code of conduct and an individual’s personal and property rights.
Own professional behaviour is assessed against an organisation’s code of conduct and own performance agreement.
Knowledge of legislation is applied to the assessment of medical claims.
Risks associated with non-activity or non-compliance that could result in liability are identified within the context of medical claims assessing.

4.
Methods, procedures and techniques of medical claims assessing are applied in terms of specific company policy, legislative requirements and industry practices.
The routes medical claims may follow are identified and a claim is assessed and processed electronically according to the rules of a selected Medical Scheme.
A medical claim is assessed using the correct codes.

Integrated Assessment

Assessment practices must be fair, transparent, valid and reliable and should ensure that no learner is disadvantaged. Learners who wish to be assessed against the competencies in the Qualification and/or associated Unit Standards should direct enquiries to the relevant ETQA.

The focus of assessment must be on the assessment of the learning outcomes rather than learning outputs. The Specific Outcomes guide the learning and training process towards the outcomes on a continuous basis. The purpose is to determine whether the outcomes have been attained. Situations should present a wide range of options. Applications should require significant choices from a wide range of procedures and in a number of contexts.

Learning, teaching and assessment are inextricably linked. Where appropriate, assessment of knowledge, skills, attitudes and values indicated in the various Unit Standards should be integrated. Assessment in Communication,
Mathematical Literacy and Financial Literacy should use authentic workplace contexts wherever practical.

Assessment has a formative monitoring function. Formative assessment should be used to assess gaps in the learners’ skill and knowledge and to indicate where there is a need for expanded opportunities. The goal is to promote learning and to assess the efficacy of the teaching and learning process. Feedback from assessment informs teaching and learning and allows for the critique of outcomes, methodology and materials. Formative assessment is diagnostic and as such it should guide the learner and the trainer. It is continuous and is used to plan appropriate learning experiences to meet the learner’s needs. It provides information about problems experienced at different stages in the learning process. As it is criterion referenced, if the learner has met the assessment criteria, he/she has achieved the outcomes.

Assessment should also have a summative component. Summative assessment may be used on completion of a Unit Standard, but should not be the only form of assessment.

A variety of methods must be used in assessment and tools and activities must be appropriate to the context in which the learner is working. Assessment should take place in an authentic context as far as is possible. Where it is not possible to assess competence in the workplace, simulations, case studies and other similar techniques should be used to provide a context appropriate to the assessment.

Integration implies that theoretical and practical components should, where possible, be assessed together. Integrative techniques should be used to assess applied competence. Learners should be required to demonstrate that they can perform the outcomes with understanding and insight.

Assessment should ensure that all Specific Outcomes, embedded knowledge and Critical Cross-Field Outcomes are evaluated. Assessment of the Critical Cross-Field Outcomes should be integrated with the assessment of the Specific Outcomes. The Critical Cross-Field Outcomes are implicit in some Unit Standards and programmes should be designed to extend and further reflect the integration.

Before the FETC is awarded, learners are required to demonstrate competence in the required Unit Standards and complete a summative assessment based on the exit outcomes of the Qualification.