Claims Administration – Good Practice by ChrisBirchall

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									                     Carrying out management checks to ensure staff are processing claims accurately – Good Practice
No.        Good Practice                                        In Place? Y/N    Action Required/Comments   Responsible   Timescale
                                                                                                            Officer

      1.   Using the results of management checks to
           review existing policies and procedures
      2.   Analysing the results of management checks
           to identify the causes of error and any
           common error patterns so that appropriate
           remedial action can be taken. Such analysis
           can identify not only specific procedural areas
           where errors are being made but also
           pinpoint individual and team areas for
           improvement/training issues.
      3.   Analysing the results of all management and
           accuracy checks across a full range of
           activities including counter-fraud and using its
           findings to identify the overall level of error in
           the caseload, inform training plans and the
           appraisal process and deliver continuous
           improvement in its performance and service
           delivery.
      4.   Reporting performance to Members and
           senior officers to sustain accountability for
           performance to predetermined delivery and
           targets
      5.   Increasing the number of checks if a high
           number of inaccuracies are found.
      6.   Including a second level check on a
           proportion of team leader checks
      7.   Ensuring that management checks confirm
           the following :




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               Carrying out management checks to ensure staff are processing claims accurately – Good Practice
No.   Good Practice                                         In Place? Y/N    Action Required/Comments   Responsible   Timescale
                                                                                                        Officer
                                                                    NEW CLAIMS
            Is the claim form complete?
            Has all original evidence been
             verified?
            Is it a new claim and not a change of
             circumstance?
            Is there documented evidence to
             confirm:
                o     compliance with section 1(1A)
                      and 1(1B) of the Social
                      Security Administration Act
                      1992 (SSAA)?
                o     the identity of customer, and
                      partner, when applicable?
                o     the liability to pay rent and/or
                      Council Tax?
                o     residency?
                o     receipt of IS/JSA(IB) or
                      Pension Credit in applicable
                      cases?
                o     for non IS/JSA(IB) or Pension
                      Credit claims, full verification of
                      all income?
                o     for non IS/JSA(IB) or Pension
                      Credit claims, full verification of
                      all capital?
                o     for savings credit only Pension

                                                                            Page 2 of 10
               Carrying out management checks to ensure staff are processing claims accurately – Good Practice
No.   Good Practice                                      In Place? Y/N    Action Required/Comments   Responsible   Timescale
                                                                                                     Officer
                      Credit cases, any income
                      which results in a modification
                      of the assessed income figure
                      provided by the DWP?
                o     income of non-dependants,
                      when applicable?
            has the correct date of claim been
             used?
            Was a payment on account (POA)
             considered when appropriate?
            Was a Rent Officer referral
             applicable? If so, was it referred to the
             Rent Service within 3 days of receipt
             of the completed claim form or 2 days
             for a pre-tenancy determination?
            Does a valid Rent Officer
             determination exist when appropriate?
            When a decision to pay the landlord
             direct has been made, has the fit and
             proper person test been considered
             and documented?
            Have all foreseeable changes of
             circumstances been taken into
             account and diarised?
            Have details of income, capital and
             rent been correctly recorded to ensure
             the benefit calculation is correct?
            Have all details been recorded


                                                                         Page 3 of 10
                     Carrying out management checks to ensure staff are processing claims accurately – Good Practice
No.        Good Practice                                     In Place? Y/N    Action Required/Comments   Responsible   Timescale
                                                                                                         Officer
                   correctly on the benefit IT system,
                   including personal details for customer
                   and partner and landlord?
                  Have the appropriate payment terms
                   been applied?
                  Has any request for backdating been
                   considered and processed in a timely
                   manner with supporting evidence?
                  Has the management check looked
                   for unnecessary delays
                                                              NOT ENTITLED DECISIONS
      8.
                  Has the customer been asked to
                   provide appropriate information to
                   support their claim?
                  Were timescales given appropriate?
                  Was the ‘not entitled’ decision
                   correct?
                  Has the decision been correctly
                   recorded on the benefits IT system?
                  Has the appropriate decision notice
                   been sent to the customer?
                                                             CHANGE OF CIRCUMSTANCE
      9.
              Has all original evidence been verified to
               confirm the change?
              Was benefit suspended when appropriate
               to avoid an overpayment?
              Is there documented evidence to confirm

                                                                             Page 4 of 10
                  Carrying out management checks to ensure staff are processing claims accurately – Good Practice
No.   Good Practice                                          In Place? Y/N    Action Required/Comments   Responsible   Timescale
                                                                                                         Officer
          the following, if they are relevant to the
          change of circumstances:
              o    compliance with section 1(1A) and
                   1(1B) of the Social Security
                   Administration Act 1992 if
                   appropriate?
              o    the identity of customer, and
                   partner, when applicable?
              o    the liability to pay rent and/or
                   Council Tax?
              o    residency?
              o    receipt of IS/JSA(IB) or Pension
                   Credit in applicable cases?
              o    for non IS/JSA(IB) or Pension
                   Credit claims, full verification of all
                   income?
              o    for non IS/JSA(IB) or Pension
                   Credit claims, full verification of all
                   capital?
              o    for savings credit only Pension
                   Credit cases, any income which
                   results in a modification of the
                   assessed income figure provided
                   by DWP?
              o    income of non-dependants, when
                   applicable?
         Has the correct effective date of change
          been applied?

                                                                             Page 5 of 10
                       Carrying out management checks to ensure staff are processing claims accurately – Good Practice
No.         Good Practice                                    In Place? Y/N    Action Required/Comments   Responsible     Timescale
                                                                                                         Officer
               Have any other foreseeable changes of
                circumstance been taken into account and
                diarised?
               Does a valid Rent Officer determination
                exist, if appropriate?
               Has the change of circumstances been
                correctly recorded on the benefit IT
                system, if appropriate?
               Has an overpayment been raised, when
                appropriate?
               If an overpayment was raised, check the
                following additional areas:
                   o    is the classification correct and
                        documented?
                   o    has recoverability been considered
                        correctly and documented?
                   o    has the person from whom to
                        recover been considered correctly
                        and documented?
                   o    is the appropriate method of
                        recovery being sought?
                   o    could the overpayment have been
                        avoided by the LA?
                                                                   OVERPAYMENTS
      10.
               Has all original evidence been verified to
                confirm the change of circumstance?
               Is there documented evidence to confirm

                                                                             Page 6 of 10
                Carrying out management checks to ensure staff are processing claims accurately – Good Practice
No.   Good Practice                                      In Place? Y/N    Action Required/Comments   Responsible   Timescale
                                                                                                     Officer
          the following, if they are relevant to the
          overpayment calculation?
                  o   compliance with section 1(1A)
                      and 1(1B) of the Social
                      Security Administration Act
                      1992?
                  o   the identity of customer, and
                      partner when applicable?
                  o   the liability to pay rent and or
                      Council Tax?
                  o   residency?
                  o   receipt of IS/JSA(IB) or
                      Pension Credit in applicable
                      cases?
                  o   for non IS/JSA(IB) or Pension
                      Credit claims, full verification
                      of all income?
                  o   for non IS/JSA(IB) or Pension
                      Credit claims, full verification
                      of all capital?
                  o   for savings credit only Pension
                      Credit cases, any income
                      which results in a modification
                      of the assessed income figure
                      provided by DWP?
                  o   income of non-dependants,
                      when applicable?
         Has the correct effective date of change


                                                                         Page 7 of 10
                       Carrying out management checks to ensure staff are processing claims accurately – Good Practice
No.         Good Practice                                     In Place? Y/N    Action Required/Comments   Responsible    Timescale
                                                                                                          Officer
                been applied?
               Has the change of circumstance been
                correctly recorded on the benefit IT
                system, when appropriate?
               Has any underlying entitlement been
                established before issuing the
                overpayment decision notice?
               Have returned or uncashed cheques been
                taken into account?
               Is the classification correct and
                documented?
               Has recoverability been considered
                correctly and documented?
               Has the person from whom to recover the
                overpayment been considered correctly
                and documented?
               Is the appropriate method of recovery
                being sought?
               Could the overpayment have been
                avoided by the LA?
      11.
            Maintaining a record of all errors identified
            and using this to inform
                   o    training provision – results should
                        be analysed to ascertain if
                        individual or group training is
                        appropriate
                   o    the appraisal cycle
                   o    working practices

                                                                              Page 8 of 10
                      Carrying out management checks to ensure staff are processing claims accurately – Good Practice
No.         Good Practice                                   In Place? Y/N    Action Required/Comments   Responsible     Timescale
                                                                                                        Officer
                  o    the redesign of the risk based
                       checking strategy taking account
                       of common areas of error and
                       difficulty.
      12. Analysing results of data matches and risk
          based reviews to identify trends and patterns
          in error in the caseload.
      13. Taking action to address issues identified by,
               for example
                               reviewing business
                                processes
                               considering training
                                provision
                               closing loopholes in
                                administration
      14.
            Analysing the causes for overpayments. The
            analysis should be fed back to appropriate
            employees to
                               prevent future
                                overpayments occurring
                               secure the gateway to the
                                benefits system.
      15. Setting targets for reducing the number of LA
          error overpayments.
      16. Providing individual employees with feedback
          on their performance.
      17. Collaborating with other LAs in bench
          marking clubs to compare quantitative
          performance data and identify how
          performance differs from that of other LAs to

                                                                            Page 9 of 10
               Carrying out management checks to ensure staff are processing claims accurately – Good Practice
No.   Good Practice                             In Place? Y/N     Action Required/Comments       Responsible     Timescale
                                                                                                 Officer
      act as a spur to improve performance.




                                                                Page 10 of 10

								
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