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Elements and Performance Criteria

  1. Determine terms and conditions of settlement
  2. Negotiate and communicate settlement terms
  3. Document liability decisions
  4. Finalise settlement
  5. Identify any required changes to policy or procedures
  6. Report findings and update records

Required Skills

Required skills

highlydeveloped communication skills to

determine and confirm information using questioning and active listening as required

relate effectively to customers

liaise with others share information listen and understand

use language and concepts appropriate to cultural differences

welldeveloped numeracy and IT skills to

interpret charts graphs and statistical information and calculate settlement offers

use computer applications word processing spreadsheet database specific purpose computer systems to assist in achieving required outcomes

access and update records electronically

access webbased information services

welldeveloped literacy skills to read and interpret documentation from a variety of sources and record and consolidate relevant related information

learning skills to maintain knowledge of changes to compliance legislation and requirements

problem solving skills to identify any issues that have the potential to impact on work outcomes and to develop options to resolve these issues when they arise

selfmanagement skills for complying with ethical legal and procedural requirements research and analysis skills for accessing and interpreting relevant information

organisational skills including the ability to plan and sequence work

Required knowledge

accountability requirements

application of legal precedents

dispute resolution bodies

level at which claim should be referred to senior staff

organisation business objectives

organisation policy procedures guidelines and authorities

regulatory body requirements

relevant legislation and industry compliance requirements

relevant common law legal systems and procedures

rights of subrogation the more complex the claim the more parties may be involved

rolesresponsibilitiesjurisdiction of specialists and other authorities

types and categories of insurance policies industry codes of practice insurance trends and relevant legislation

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

interpret and apply organisation policy and procedures and compliance with legislation and regulations and industry codes of practice in identifying nonroutine aspects of the claim and effecting an acceptable settlement

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 organisation records

access to organisation policies and procedures

Method of assessment

A range of assessment methods should be used to assess practical skills and knowledge The following examples in combination 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.

Non-routine aspects may include:

disputes in other jurisdictions

special inclusions and exclusions.

Non-routine/complex claims may involve:

claims involving legal procedures, including those that involve working across international boundaries

claims involving long-term settlements

complex claims involving major losses and bodily injury losses

complex technical determinations

high monetary impact

important client base.

Settlement terms may include:

repair, replace or cash settle.

Client and/or relevant parties may include:

broker or agent

claimant or client

consultants

government or statutory authorities

insured

legal or other practitioners

manufacturers

medical

mortgagee

principal

reinsurer

subcontractor

suppliers

third party

trustee.

Adjustment may involve modifications of settlement terms based on:

new facts

negotiating the best terms.

Documentation may include:

legal, government, professional and other documents

meeting notes

minutes

official, general and other correspondence

reasons for recommending certain actions and settlement decisions over others

records of telephone conversations

reference to all data and information considered

reports from others such as loss adjusters, assessors, insurers, medical providers and others

the basis on which the decision was determined.

Stakeholders may include:

claimants

claims managers and specialists

insurance broker

reinsurers

underwriters

other relevant parties.