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Elements and Performance Criteria

Required Skills

Required skills

communication skills to

gather and check information

liaise and share information with others

communicate appropriately with people from diverse backgrounds

use computer applications word processing spreadsheet database specific purpose computer systems

access and update records electronically

access webbased information services

numeracy skills to interpret numeric data and relevant statistics and make payment calculations

organisational skills to efficiently plan and sequence work

problem solving skills to address errors in life insurance documentation

reading skills to

read and understand relevant procedures

read and understand life insurance policies

read and interpret life insurance claims and supporting documentation

research and analysis skills to

identify and interpret relevant information

analyse information and data

maintain currency of products and services knowledge

writing skills to

accurately record information

prepare professional letters and emails

Required knowledge

the ability to apply and explain as relevant to the management of complex life insurance claims

dispute resolution policy and procedures

industry practice and ethical standards in claims risk management

life insurance administrative requirements

life insurance policy payment criteria

life insurance policy terms and conditions

organisational procedures

procedures for processing complex prudential claims

product information

relevant regulatory requirements

Evidence Required

The evidence guide provides advice on assessment and must be read in conjunction with the performance criteria required skills and knowledge range statement and the Assessment Guidelines for the Training Package

Overview of assessment

Critical aspects for assessment and evidence required to demonstrate competency in this unit

Evidence of the ability to

apply highly developed analytical and administrative skills to complex claims assessment

maintain and apply a thorough understanding of all aspects of claims procedures and administrative requirements

perform tasks in accordance with relevant procedures and regulatory requirements

Context of and specific resources for assessment

Assessment must ensure

competency is demonstrated in the context of the work environment and conditions specified in the range statement either in a relevant workplace or a closely simulated work environment

access to and the use of a range of common office equipment technology software and consumables

access to records

access to organisational policies and procedures

Method of assessment

A range of assessment methods should be used to assess practical skills and knowledge The following examples are appropriate for this unit

evaluating an integrated activity which combines the elements of competency for the unit or a cluster of related units of competency

observing processes and procedures in workplaces

verbal or written questioning on underpinning knowledge and skills

evaluating samples of work

accessing and validating third party reports

setting and reviewing workplace projects and business simulations or scenarios

Guidance information for assessment

Range Statement

The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.

Life insurance policy may include:	disability income endowment term life (including terminal illness and Total and Permanent Disablement (TPD)) trauma whole of life.
Valid must include:	policy exists policy is current claimant is legally authorised to act on the policy.
Documentation may include:	claim forms records of death records of disablement other medical records statutory declarations and other such records.
Complex claims may be claims that involve:	legal procedures, including those that involve working across international boundaries long-term settlements complex medical conditions complex technical determinations high monetary impact an important client base.
Procedures may include:	organisational complaints handling processes organisational customer service charter organisational guidelines organisational policy organisational privacy and confidentiality guidelines organisational procedures.
Payment criteria may include:	death (including terminal illness) invalidity (permanent or temporary disability) trauma.
Policy exclusions may include:	pre-existing illnesses medical conditions high risk activities.
Further information may include:	medical evidence financial evidence interview records surveillance records.
Specialists may include:	advisers investigators medical and related practitioners solicitors forensic accountants.
Ethical and regulatory requirements may include:	corporations legislation life insurance legislation privacy legislation Australian Securities and Investments Commission (ASIC) regulatory guides industry Codes of Practice professional Codes of Practice.
Appropriate stakeholders may include:	internal parties: administrators investigation agencies medical officers trustees client and associated parties: assignees beneficiaries executors lawyers life insured next of kin policy owners.
Consequences may include:	loss or reduction of future life insurance cover termination of the present contract inability to claim again for the same event under the present contract.
Policy discharge may include:	acceptance by client of amount of settlement acceptance by client of timing of settlement acceptance by client of terms of settlement.