Unit of Competency Mapping – Information for Teachers/Assessors – Information for Learners

FNSISV306A Mapping and Delivery Guide
Receive and record or register a claim

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency FNSISV306A - Receive and record or register a claim
Description This unit describes the performance outcomes, skills and knowledge required to receive and record or register claims including gathering the information, initial estimation and entering the claim into organisation records.This unit is applicable to individuals working within enterprises and job roles subject to licensing, legislative, regulatory or certification requirements including legislation administered by the Australian Securities and Investments Commission (ASIC).
Employability Skills This unit contains employability skills.
Learning Outcomes and Application This unit applies to job roles involving insurance claims in a range of insurance sectors and may be applied within organisations of various sizes and across a range of customer bases.
Duration and Setting X weeks, nominally xx hours, delivered in a classroom/online/blended learning setting.
Prerequisites/co-requisites
Competency Field
Development and validation strategy and guide for assessors and learners Student Learning Resources Handouts
Activities 		Slides
PPT 		Assessment 1 Assessment 2 Assessment 3 Assessment 4
Elements of Competency Performance Criteria              
Element: Receive notification of claim
  • Customer is advised of claims procedure
  • Customer is given comprehensive information on the organisation claims procedure, how to make a claim, and any forms required for claim are sent to customer
  • Customer queries are answered clearly and accurately
       
Element: Receive claim
  • New claims advice is checked to verify correct policy detail
  • Claims records are checked to ensure that the claim has not been registered previously
       
Element: Record/register claim
  • Claims data is accurately entered and claims are registered in accordance with organisation procedures and level of authority
  • Where necessary government authorities are notified in the correct format
       
Element: Estimate a claims reserve, including reinsurance as appropriate
  • A preliminary reserve/estimate is calculated, where appropriate, according to organisation reserving policy
  • For a routine claim, a determination may be made on acceptance or referral of claim in accordance with organisation policy and procedures
  • Need for internal or external service providers is identified, if appropriate
  • Policy is checked for reinsurance details, if applicable
  • Reinsurers are advised of potential claim, if applicable, by raising reinsurance advice
  • Potential impact of the claim on the premium is reported as required
       
Element: Create claim files or add information to existing files
  • Correspondence is filed in correct claims files and allocated to relevant claims operatives
  • All missing information, abnormalities or classification uncertainties are referred according to organisation policy
  • An appropriate date is entered into diary system, where necessary
  • All information is completed accurately and clearly, and in accordance with legislative and organisation requirements
  • Completed documentation is filed or referred for processing if appropriate
       


Evidence Required

List the assessment methods to be used and the context and resources required for assessment. Copy and paste the relevant sections from the evidence guide below and then re-write these in plain English.

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:

fully comply with organisation operating procedures, legislative requirements and industry codes of practice

use accuracy and attention to detail and thorough checking of data.

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.

Guidance information for assessment

Submission Requirements

List each assessment task's title, type (eg project, observation/demonstration, essay, assignment, checklist) and due date here

Assessment task 1: [title]      Due date:

(add new lines for each of the assessment tasks)

Assessment Tasks

Copy and paste from the following data to produce each assessment task. Write these in plain English and spell out how, when and where the task is to be carried out, under what conditions, and what resources are needed. Include guidelines about how well the candidate has to perform a task for it to be judged satisfactory.

Required skills

communication skills to:

determine and confirm information, using questioning and active listening as required

relate to customers

liaise with others, share information, listen and understand

use language and concepts appropriate to cultural differences

numeracy and IT skills to:

perform calculations related to achieving required outcomes

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

access and update records electronically

access web-based information services

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

research and analysis skills for accessing and interpreting relevant information

organisational skills, including the ability to plan and sequence work

Required knowledge

IT and communications systems

organisation and industry sector policy wording

principles and methods of filing

product knowledge, including any conditions and terms of reinsurance

relevant legislation and regulations, organisation policy and procedures, underwriting guidelines and authorities

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.

Claims checking involves:

manual checklists or through data entry validation on computer systems and may include:

previous payment to claimant

claim has been sent to the wrong insurer

liability has not been accepted.

Entering claims data may include:

coding according to organisation requirements (entering statistical data).

Registering claims may involve:

entering claims reserve/estimate

identifying interested parties

identifying reinsurance involvement

linking to relative policy

observing limits to authority level

recording in system.

Organisation procedures may include:

correspondence presentation

initiation of new claims and processing of claims

security procedures.

Authorities may include:

a written policy and procedures manuals that define the level of authority to make decisions on claims within the organisation

guidelines/procedures relating to injury management and use of service providers.

Systems may be:

computerised, with record updating by electronic or manual data recording.

Service providers may include

accountants

assessors

auditors

engineers

investigators

medical advisers

private investigators

surveyors

others as required.

If reinsurance is identified:

check specific treaty and/or facultative coverage for catastrophic claims and allocate internal category code.

Reinsurance advice may include:

notifying the reinsurer of potential claim (if appropriate) by raising a credit/debit note.

Legislative and organisational requirements may include:

Health and Other Services (Compensation) Act

industrial relations legislation

Privacy Act

social security legislation

State and Territory workers compensation Acts and regulations

taxation legislation.

Copy and paste from the following performance criteria to create an observation checklist for each task. When you have finished writing your assessment tool every one of these must have been addressed, preferably several times in a variety of contexts. To ensure this occurs download the assessment matrix for the unit; enter each assessment task as a column header and place check marks against each performance criteria that task addresses.

Observation Checklist

Tasks to be observed according to workplace/college/TAFE policy and procedures, relevant legislation and Codes of Practice Yes No Comments/feedback
Customer is advised of claims procedure 
Customer is given comprehensive information on the organisation claims procedure, how to make a claim, and any forms required for claim are sent to customer 
Customer queries are answered clearly and accurately 
New claims advice is checked to verify correct policy detail 
Claims records are checked to ensure that the claim has not been registered previously 
Claims data is accurately entered and claims are registered in accordance with organisation procedures and level of authority 
Where necessary government authorities are notified in the correct format 
A preliminary reserve/estimate is calculated, where appropriate, according to organisation reserving policy 
For a routine claim, a determination may be made on acceptance or referral of claim in accordance with organisation policy and procedures 
Need for internal or external service providers is identified, if appropriate 
Policy is checked for reinsurance details, if applicable 
Reinsurers are advised of potential claim, if applicable, by raising reinsurance advice 
Potential impact of the claim on the premium is reported as required 
Correspondence is filed in correct claims files and allocated to relevant claims operatives 
All missing information, abnormalities or classification uncertainties are referred according to organisation policy 
An appropriate date is entered into diary system, where necessary 
All information is completed accurately and clearly, and in accordance with legislative and organisation requirements 
Completed documentation is filed or referred for processing if appropriate 

Forms

Assessment Cover Sheet

FNSISV306A - Receive and record or register a claim
Assessment task 1: [title]

Student name:

Student ID:

I declare that the assessment tasks submitted for this unit are my own work.

Student signature:

Result: Competent Not yet competent

Feedback to student

 

 

 

 

 

 

 

 

Assessor name:

Signature:

Date:

Assessment Record Sheet

FNSISV306A - Receive and record or register a claim

Student name:

Student ID:

Assessment task 1: [title] Result: Competent Not yet competent

(add lines for each task)

Feedback to student:

 

 

 

 

 

 

 

 

Overall assessment result: Competent Not yet competent

Assessor name:

Signature:

Date:

Student signature:

Date: