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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

conduct structured interviews with case management

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 calculate benefit entitlements

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 disability claims

industry practice and ethical standards in disability claims management

life insurance administrative requirements

life insurance policy payment criteria

life insurance policy terms and conditions

organisational procedures

practice in prudential risk associated with disability claims in insurance

procedure and practice in insurance claims investigation

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

maintain and apply a thorough understanding of claims procedures policy guidelines 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.

Need to undertake a review may include:	a change in the claimant's situation anomalies detected during the initial claim assessment indexation scheduling medical updates new and relevant information recovery benchmarks standard scheduling as per processes and procedures suspicions of fraud.
Periodical claimant submissions may include:	activities questionnaires other medical, financial and occupational information progress claim forms progress medical reports rehabilitation reports.
Relevant parties may include:	accounting and finance professionals advisers carers claimant consultants legal or other practitioners medical professionals reinsurer trustees workers compensation.
Additional information may include:	additional claimant forms functional capacity evaluation information related to moral risks interview records medical reports meeting notes official, general and other correspondence psychological assessment records of telephone conversations reports from others such as assessors, insurers, medical providers and others surveillance tax documentation vocational assessment.
Ethical and regulatory requirements may include:	Australian Securities and Investments Commission (ASIC) regulatory guides corporations legislation life insurance legislation privacy legislation professional Codes of Practice.
Specialists may include:	advisers Chief Medical Officer consultants forensic accountants investigators medical professionals solicitors surveillance professionals.
Procedures may include:	organisational complaints handling processes organisational customer service charter organisational guidelines organisational policy organisational privacy and confidentiality guidelines organisational procedures.
Results of assessments may include:	decision to alter benefit payments decision to cease benefit payments decision to continue benefit payments unaltered.