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

FNSISV309A Mapping and Delivery Guide
Settle claims

Version 1.0
Issue Date: April 2024


Qualification -
Unit of Competency FNSISV309A - Settle claims
Description This unit describes the performance outcomes, skills and knowledge required to settle claims including the negotiation of terms, recording of detail, finalisation of payments and filing of documents.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 settling 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: Calculate claim entitlement
  • Information is gathered and evaluated to determine the amount of loss suffered by the customer
  • Settlement terms are determined according to policy wording, legislation and codes of practice
       
Element: Negotiate and communicate settlement terms
  • Terms and conditions of settlement offer are promptly advised to client and/or third party according to organisation claims procedures, where appropriate
  • Response by client and/or third party to terms of settlement offer is considered to assess whether adjustment is required to take into account the value of lost or damaged goods
  • Negotiation is undertaken in an endeavour to reach mutual agreement on valuation
  • Terms and conditions of settlement offer are modified as necessary and client and/or third party advised promptly
       
Element: Document liability decisions
  • Claim decisions are clearly communicated to the relevant parties in a manner required by the policy wording, the legislation, organisation operating procedures and codes of practice
  • Decisions are documented in such a way as to determine the basis on which the decision was reached and all the evidence/information that was considered, where applicable
  • Claims documentation is sent to reinsurers
       
Element: Finalise settlement
  • Once settlement is reached, payments are made/instructed within the required timeframe
  • Settlement release is obtained from client and/or third party, as applicable
  • Claim referred for recovery action if appropriate, and loss recovery agent appointed if applicable
  • Recovery action is initiated from reinsurers if applicable
  • Finalised claims files are stored and maintained according to organisation policy and 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.

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:

apply organisation policy and procedures and comply with legislation and regulations and industry codes of practice.

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

accountability requirements

level at which claim should be referred to senior staff

organisation philosophy, policy and procedures

policy coverage

relevant industry legislation

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.

Customer may be:

a third party

an agent or a lawyer acting for the client

the client.

Settlement terms may include:

cash settle

ex gratia payments

repair

replace

total loss

vouchers.

Claim decisions may be:

cancellation of claim (excess greater than settlement)

need further details

partial settlement

payment

repair approval

replacement approval.

Recovery action may include:

determining financial status of third party

determining liability of third party

recovery from reinsurers

salvage.

Storage of data may be:

electronic or hard copy (paper).

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
Information is gathered and evaluated to determine the amount of loss suffered by the customer 
Settlement terms are determined according to policy wording, legislation and codes of practice 
Terms and conditions of settlement offer are promptly advised to client and/or third party according to organisation claims procedures, where appropriate 
Response by client and/or third party to terms of settlement offer is considered to assess whether adjustment is required to take into account the value of lost or damaged goods 
Negotiation is undertaken in an endeavour to reach mutual agreement on valuation 
Terms and conditions of settlement offer are modified as necessary and client and/or third party advised promptly 
Claim decisions are clearly communicated to the relevant parties in a manner required by the policy wording, the legislation, organisation operating procedures and codes of practice 
Decisions are documented in such a way as to determine the basis on which the decision was reached and all the evidence/information that was considered, where applicable 
Claims documentation is sent to reinsurers 
Once settlement is reached, payments are made/instructed within the required timeframe 
Settlement release is obtained from client and/or third party, as applicable 
Claim referred for recovery action if appropriate, and loss recovery agent appointed if applicable 
Recovery action is initiated from reinsurers if applicable 
Finalised claims files are stored and maintained according to organisation policy and legislative requirements and codes of practice, as applicable 

Forms

Assessment Cover Sheet

FNSISV309A - Settle 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

FNSISV309A - Settle 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: