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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. Review claims reserves and monitor funds
   • Review claims reserves regularly to ensure they accurately reflect expectations
   • Monitor funds to ensure adequate reserves exist to pay claims as they fall due for payment
   • Provide accurate data to assist underwriters to identify and charge appropriate policy premiums
2. Support claims staff in claims reserve activities
   • Ensure claims coordination staff are supported, as required, to identify accurate initial claims reserves
   • Ensure claims coordination staff are supported, as required, in allocation of claims to appropriate claims specialists
3. Authorise payments, settlements and changes to reserves
   • Authorise payments, settlements and reserves changes that are requested or required by claims specialists but outside their delegated authority
4. Identify required changes to portfolio, claims reserves policy or procedures
   • Communicate identified information promptly to decision-makers in the management structure according to organisational procedures
   • Instigate changes to policy and procedures to minimise claims losses in similar circumstances

Performance Evidence

Evidence of the ability to:

undertake high level data collection, financial analysis and monitoring of funds for managing claims reserves

apply effective communication and management skills related to the review, update and reporting in an insurance claims portfolio

accurately interpret and comply with relevant legislation, and claims and reserves trends.

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 data analysis techniques relating to claims reserves

outline industry trends in claims reserving policy and procedures

outline relevant information technology and communications systems required for determining claims reserves

outline key features of insurance guidelines, levels of authority and organisational policy, procedures and obligations in reserving

identify and describe key features of relevant legislation, regulatory guidelines and industry sector codes of practice

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

explain the reinsurance processes and implications on claims reserves

explain risk prevention and loss minimisation methods and application to claims reserves

explain types and categories of insurance policies

outline processes for authorising payments, settlements and reserves changes.

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