Assessor Resource

FNSISV517
Review claims settlement policies and procedures

Assessment tool

Version 1.0
Issue Date: May 2024


This unit describes the skills and knowledge required to review the effectiveness of claims settlement policy and procedures, including monitoring trends in claims settlement and formulating changes to minimise losses.

It applies to individuals involved in the development and monitoring of policy and procedures associated with organisational underwriting risk within the insurance sector.

Work functions in the occupational areas where this unit may be used are subject to regulatory requirements. Refer to the FNS Implementation Guide Companion Volume or the relevant regulator for specific guidance on requirements.

You may want to include more information here about the target group and the purpose of the assessments (eg formative, summative, recognition)


Evidence Required

List the assessment methods to be used and the context and resources required for assessment. Copy and paste the relevant sections from the evidence guide below and then re-write these in plain English.

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

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

1. Collect data on claims trends

1.1 Design and implement data gathering processes

1.2 Identify new data requirements and sources of information, and establish process for collecting data

1.3 Research industry claims settlement trends to benchmark against

2. Monitor and report on claims trends

2.1 Analyse data collected to identify trends

2.2 Prepare accurate and timely claims reports to document trends, where appropriate

2.3 Recommend appropriate improvements to claims settlement policy and procedures

3. Identify required changes to portfolio, claims settlement policy or procedures

3.1 Communicate promptly information which impacts on various portfolios to management, according to company procedures

3.2 Instigate changes to policy and procedures to minimise future losses

Evidence of the ability to:

effectively collect and interpret claims settlement data from a wide range of sources

thoroughly analyse the trends and the effects on claims settlement policies and procedures

document and communicate changes required in claims settlement policies and procedures.

Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.

To complete the unit requirements safely and effectively, the individual must:

outline organisational policy, procedures and guidelines for claims settlement

outline data collection design and practice

outline data analysis techniques relating to claims settlement

describe industry trends in insurance prudential risk management

explain portfolio management techniques in insurance prudential risk management

analyse reasons for losses as a result of poor claims settlement policy and procedures, and recommend improvements to avoid recurrence.

Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance services field of work and include access to:

organisational records

organisational policy, procedures, legislation and regulations as they relate to contracts of insurance

a range of common technology and software.

Assessors must satisfy NVR/AQTF assessor requirements.

Submission Requirements

List each assessment task's title, type (eg project, observation/demonstration, essay, assingnment, checklist) and due date here

Assessment task 1: [title]      Due date:

(add new lines for each of the assessment tasks)

Assessment Tasks

Copy and paste from the following data to produce each assessment task. Write these in plain English and spell out how, when and where the task is to be carried out, under what conditions, and what resources are needed. Include guidelines about how well the candidate has to perform a task for it to be judged satisfactory.

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

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

1. Collect data on claims trends

1.1 Design and implement data gathering processes

1.2 Identify new data requirements and sources of information, and establish process for collecting data

1.3 Research industry claims settlement trends to benchmark against

2. Monitor and report on claims trends

2.1 Analyse data collected to identify trends

2.2 Prepare accurate and timely claims reports to document trends, where appropriate

2.3 Recommend appropriate improvements to claims settlement policy and procedures

3. Identify required changes to portfolio, claims settlement policy or procedures

3.1 Communicate promptly information which impacts on various portfolios to management, according to company procedures

3.2 Instigate changes to policy and procedures to minimise future losses

Evidence of the ability to:

effectively collect and interpret claims settlement data from a wide range of sources

thoroughly analyse the trends and the effects on claims settlement policies and procedures

document and communicate changes required in claims settlement policies and procedures.

Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.

To complete the unit requirements safely and effectively, the individual must:

outline organisational policy, procedures and guidelines for claims settlement

outline data collection design and practice

outline data analysis techniques relating to claims settlement

describe industry trends in insurance prudential risk management

explain portfolio management techniques in insurance prudential risk management

analyse reasons for losses as a result of poor claims settlement policy and procedures, and recommend improvements to avoid recurrence.

Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance services field of work and include access to:

organisational records

organisational policy, procedures, legislation and regulations as they relate to contracts of insurance

a range of common technology and software.

Assessors must satisfy NVR/AQTF assessor requirements.
Copy and paste from the following performance criteria to create an observation checklist for each task. When you have finished writing your assessment tool every one of these must have been addressed, preferably several times in a variety of contexts. To ensure this occurs download the assessment matrix for the unit; enter each assessment task as a column header and place check marks against each performance criteria that task addresses.

Observation Checklist

Tasks to be observed according to workplace/college/TAFE policy and procedures, relevant legislation and Codes of Practice Yes No Comments/feedback
Design and implement data gathering processes 
Identify new data requirements and sources of information, and establish process for collecting data 
Research industry claims settlement trends to benchmark against 
Analyse data collected to identify trends 
Prepare accurate and timely claims reports to document trends, where appropriate 
Recommend appropriate improvements to claims settlement policy and procedures 
Communicate promptly information which impacts on various portfolios to management, according to company procedures 
Instigate changes to policy and procedures to minimise future losses 

Forms

Assessment Cover Sheet

FNSISV517 - Review claims settlement policies and procedures
Assessment task 1: [title]

Student name:

Student ID:

I declare that the assessment tasks submitted for this unit are my own work.

Student signature:

Result: Competent Not yet competent

Feedback to student

 

 

 

 

 

 

 

 

Assessor name:

Signature:

Date:

Assessment Record Sheet

FNSISV517 - Review claims settlement policies and procedures

Student name:

Student ID:

Assessment task 1: [title] Result: Competent Not yet competent

(add lines for each task)

Feedback to student:

 

 

 

 

 

 

 

 

Overall assessment result: Competent Not yet competent

Assessor name:

Signature:

Date:

Student signature:

Date: