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Follow the links below to find material targeted to the unit's elements, performance criteria, required skills and knowledge

Elements and Performance Criteria

1. Collect and organise information relating to claim
   • Obtain all relevant information to determine whether valid claim exists
   • Organise relevant information into coherent and valid body of case knowledge
   • Maintain confidentiality of information according to legislative requirements and industry principles
   • Identify any information deficiencies and seek additional information from appropriate sources
2. Research claim and validate claim information
   • Check claims information to determine legitimacy of claim, including validity of policy and whether claimant is eligible to claim on policy
   • Identify needs for investigation and/or further information and appoint appropriate service providers where necessary
   • Undertake investigation and research within established claims management criteria and authorities
   • Monitor progress of investigation, if applicable
   • Refer all missing information, abnormalities or classification uncertainties to an appropriate authority
3. Maintain records and lines of communication
   • Maintain regular contact with relevant parties to ensure they are aware of current status of claim and are actively participating in process
   • Communicate information promptly to underwriter, which impacts on policy
   • Maintain regular and accurate diary system, and adhere to timelines

Performance Evidence

Evidence of the ability to:

collect and organise sufficient information in an ordered format for processing the claim

effectively analyse and make decisions on the validity of the claim and refer to others where criteria is not met

communicate with the client and others as appropriate

accurately record, document and file all aspects of the claim

interpret and comply with industry and organisational obligations and objectives

assess any liabilities resulting from a claim that is beyond the insurance cover.

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

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Knowledge Evidence

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

explain the importance of wording of insurance policies in keeping with the organisation or industry sector

identify key compliance requirements of relevant industry legislation and regulatory guidelines

outline key features of organisational information technology and communications systems relevant to analysing insurance claims

outline organisational policy, procedures, underwriting guidelines and levels of authority

describe relevant organisational products that relate to insurance claims.

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