Assessor Resource

FNSISV525
Evaluate and report on status of insurance claims portfolios

Assessment tool

Version 1.0
Issue Date: May 2024


This unit describes the skills and knowledge required to review, analyse and evaluate an insurance claims portfolio or line of business, including preparing reports on portfolio profitability status and recommending changes to minimise losses. It involves analysing claims data and risk, reviewing claims reserves, making assumptions and recommendations about the risks, preparing reports, and monitoring trends in claims activity. It requires the use of information systems, mathematics, financial theories and statistics, risk management methodologies, and financial modelling specific to the line of business.

The unit applies to those who work in claims management and underwriting job roles involving specialist knowledge and functions in a range of insurance sectors in organisations of various sizes and across a range of client bases.

Work functions in the occupational areas where this unit may be used are subject to regulatory requirements. Users are advised to check with the relevant state and territory regulatory authorities to confirm those 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.

The candidate must demonstrate the ability to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including evidence of the ability to:

evaluate and report on status of at least one insurance claims portfolio or line of business.

In the course of the above, the candidate must:

research industry trends in portfolio management to reduce losses

make assumptions and recommendations based on findings

engage with required colleagues, communicate findings, and apply feedback.

The candidate must be able to demonstrate knowledge to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including knowledge of:

legislative requirements, regulatory guidelines and industry sector codes of practice relating to claims management and reporting

organisational policies and procedures, underwriting guidelines and levels of authority relating to evaluating and reporting on insurance claims portfolios

data and risk analysis techniques relevant to insurance claims portfolios

key aspects of financial theories and statistics relevant to insurance claims portfolios, including financial modelling and related mathematics

evaluation methodologies relevant to insurance claims portfolios

industry trends in insurance portfolio management

insurance fundamentals and methods to interpret, comprehend and apply policy wording

risk prevention and loss minimisation methods and their application in the development of claims portfolios

reporting techniques to communicate assumptions used and recommendations developed

types and categories of insurance policies.

Skills in this unit must be demonstrated in a workplace or simulated environment where the conditions are typical of those in a working environment in this industry.

This includes access to:

organisational records, data and financial models

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

common technology and software required to evaluate and report on insurance claims portfolios.

Assessors of this unit must satisfy the requirements for assessors in applicable vocational education and training legislation, frameworks and/or standards.

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.

The candidate must demonstrate the ability to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including evidence of the ability to:

evaluate and report on status of at least one insurance claims portfolio or line of business.

In the course of the above, the candidate must:

research industry trends in portfolio management to reduce losses

make assumptions and recommendations based on findings

engage with required colleagues, communicate findings, and apply feedback.

The candidate must be able to demonstrate knowledge to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including knowledge of:

legislative requirements, regulatory guidelines and industry sector codes of practice relating to claims management and reporting

organisational policies and procedures, underwriting guidelines and levels of authority relating to evaluating and reporting on insurance claims portfolios

data and risk analysis techniques relevant to insurance claims portfolios

key aspects of financial theories and statistics relevant to insurance claims portfolios, including financial modelling and related mathematics

evaluation methodologies relevant to insurance claims portfolios

industry trends in insurance portfolio management

insurance fundamentals and methods to interpret, comprehend and apply policy wording

risk prevention and loss minimisation methods and their application in the development of claims portfolios

reporting techniques to communicate assumptions used and recommendations developed

types and categories of insurance policies.

Skills in this unit must be demonstrated in a workplace or simulated environment where the conditions are typical of those in a working environment in this industry.

This includes access to:

organisational records, data and financial models

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

common technology and software required to evaluate and report on insurance claims portfolios.

Assessors of this unit must satisfy the requirements for assessors in applicable vocational education and training legislation, frameworks and/or standards.
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
Source portfolio or line of business claims data using organisational collection processes in preparation for analysis 
Identify any additional claims data sources, external influences and improvement to policies and procedures 
Identify organisation’s expectations for claims portfolio performance 
Analyse data and undertake risk analysis to determine profitability, loss ratio, claims reserves and future trends according to organisational policies and procedures 
Research industry to determine benchmarks for claims portfolio 
Identify findings and formulate assumptions and recommendations to identify trends, future profitability, claims reserves and loss ratio for the line of business 
Review and suggest amendments to policies and procedures to improve line of business financial outcomes 
Prepare a report documenting findings, identified issues and assumptions 
Communicate findings and recommendations to required stakeholders within required timeframe and according to organisational policies and procedures 
Collate feedback and identified issues, and amend report accordingly 
Submit final report for approval according to organisational lines of approval and delegation of authority 
Document final report and communicate to relevant stakeholders for implementation according to organisational procedures 

Forms

Assessment Cover Sheet

FNSISV525 - Evaluate and report on status of insurance claims portfolios
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

FNSISV525 - Evaluate and report on status of insurance claims portfolios

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: