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

FNSISV309 Mapping and Delivery Guide
Settle insurance claims

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency FNSISV309 - Settle insurance claims
Description
Employability Skills
Learning Outcomes and Application This unit describes the skills and knowledge required to settle insurance claims, including the negotiation of terms, recording of detail, finalisation of payments and filing of documents.It applies to individuals employed in a range of insurance sectors and may be applied within organisations of various sizes and across a range of customer bases.Work functions in the occupational areas where this unit may be used are subject to regulatory requirements. Refer to the FNS Implementation Guide Companion Volume or the relevant regulator for specific guidance on requirements.
Duration and Setting X weeks, nominally xx hours, delivered in a classroom/online/blended learning setting.

Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance services field of work and include access to:

organisational records

organisational policy, procedures, legislation and regulations as they relate to contracts of insurance

a range of common technology and software.

Assessors must satisfy NVR/AQTF assessor requirements.
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: Calculate claim entitlement
  • Gather and evaluate information to determine amount of loss suffered by customer
  • Determine settlement terms according to policy wording, legislation and codes of practice
       
Element: Negotiate and communicate settlement terms
  • Advise promptly terms and conditions of settlement to customer and/or third party according to organisational claims procedures, where appropriate
  • Consider response by customer and/or third party to terms of settlement offer and assess whether adjustment is required to take into account value of lost or damaged goods
  • Undertake negotiation in endeavour to reach mutual agreement on valuation
  • Modify terms and conditions of settlement as necessary and advise customer and/or third party promptly
       
Element: Document liability decisions
  • Clearly communicate claim decisions to relevant parties in manner required by policy wording, legislation, organisational operating procedures and codes of practice
  • Document decisions in such a way as to determine basis on which decision was reached and consider all evidence and information, where applicable
  • Send claims documentation to reinsurers
       
Element: Finalise settlement
  • Make or give instructions for payments within the required timeframe once settlement is reached
  • Obtain settlement release from customer and/or third party, as applicable
  • Refer claim for recovery action if appropriate, and appoint loss recovery agent if applicable
  • Initiate recovery action from reinsurers, if applicable
  • Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable
       


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.

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Calculate claim entitlement

1.1 Gather and evaluate information to determine amount of loss suffered by customer

1.2 Determine settlement terms according to policy wording, legislation and codes of practice

2. Negotiate and communicate settlement terms

2.1 Advise promptly terms and conditions of settlement to customer and/or third party according to organisational claims procedures, where appropriate

2.2 Consider response by customer and/or third party to terms of settlement offer and assess whether adjustment is required to take into account value of lost or damaged goods

2.3 Undertake negotiation in endeavour to reach mutual agreement on valuation

2.4 Modify terms and conditions of settlement as necessary and advise customer and/or third party promptly

3. Document liability decisions

3.1 Clearly communicate claim decisions to relevant parties in manner required by policy wording, legislation, organisational operating procedures and codes of practice

3.2 Document decisions in such a way as to determine basis on which decision was reached and consider all evidence and information, where applicable

3.3 Send claims documentation to reinsurers

4. Finalise settlement

4.1 Make or give instructions for payments within the required timeframe once settlement is reached

4.2 Obtain settlement release from customer and/or third party, as applicable

4.3 Refer claim for recovery action if appropriate, and appoint loss recovery agent if applicable

4.4 Initiate recovery action from reinsurers, if applicable

4.5 Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable

Evidence of the ability to:

evaluate information and then calculate the claim entitlement

engage in negotiation with the customer to determine agreed settlement

prepare all required documentation and file as appropriate.

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

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

state the accountability requirements of individuals involved with insurance settlements and identify the level at which settlements should be referred to senior staff

outline key features of organisational policy and procedures required for processing insurance claims

outline key features of relevant legislation, regulation and codes of practice that apply to insurance claims

define the term ‘policy coverage’ and state how it relates to the settlement of insurance claims.

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.

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Calculate claim entitlement

1.1 Gather and evaluate information to determine amount of loss suffered by customer

1.2 Determine settlement terms according to policy wording, legislation and codes of practice

2. Negotiate and communicate settlement terms

2.1 Advise promptly terms and conditions of settlement to customer and/or third party according to organisational claims procedures, where appropriate

2.2 Consider response by customer and/or third party to terms of settlement offer and assess whether adjustment is required to take into account value of lost or damaged goods

2.3 Undertake negotiation in endeavour to reach mutual agreement on valuation

2.4 Modify terms and conditions of settlement as necessary and advise customer and/or third party promptly

3. Document liability decisions

3.1 Clearly communicate claim decisions to relevant parties in manner required by policy wording, legislation, organisational operating procedures and codes of practice

3.2 Document decisions in such a way as to determine basis on which decision was reached and consider all evidence and information, where applicable

3.3 Send claims documentation to reinsurers

4. Finalise settlement

4.1 Make or give instructions for payments within the required timeframe once settlement is reached

4.2 Obtain settlement release from customer and/or third party, as applicable

4.3 Refer claim for recovery action if appropriate, and appoint loss recovery agent if applicable

4.4 Initiate recovery action from reinsurers, if applicable

4.5 Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable

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
Gather and evaluate information to determine amount of loss suffered by customer 
Determine settlement terms according to policy wording, legislation and codes of practice 
Advise promptly terms and conditions of settlement to customer and/or third party according to organisational claims procedures, where appropriate 
Consider response by customer and/or third party to terms of settlement offer and assess whether adjustment is required to take into account value of lost or damaged goods 
Undertake negotiation in endeavour to reach mutual agreement on valuation 
Modify terms and conditions of settlement as necessary and advise customer and/or third party promptly 
Clearly communicate claim decisions to relevant parties in manner required by policy wording, legislation, organisational operating procedures and codes of practice 
Document decisions in such a way as to determine basis on which decision was reached and consider all evidence and information, where applicable 
Send claims documentation to reinsurers 
Make or give instructions for payments within the required timeframe once settlement is reached 
Obtain settlement release from customer and/or third party, as applicable 
Refer claim for recovery action if appropriate, and appoint loss recovery agent if applicable 
Initiate recovery action from reinsurers, if applicable 
Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable 

Forms

Assessment Cover Sheet

FNSISV309 - Settle insurance claims
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

FNSISV309 - Settle insurance claims

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: