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

FNSISV405 Mapping and Delivery Guide
Analyse insurance claims

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency FNSISV405 - Analyse insurance claims
Description
Employability Skills
Learning Outcomes and Application This unit describes the skills and knowledge required to analyse insurance claims including researching and validating the claim information, and maintaining records and lines of communication.It applies to individuals whose job roles involve client service, data processing or underwriting in a range of insurance sectors and may be applied within organisations of various sizes and across a range of client 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: Collect and organise information relating to claim
  • Obtain all relevant information to determine whether valid claim exists
  • Organise relevant information into coherent and valid body of case knowledge
  • Maintain confidentiality of information according to legislative requirements and industry principles
  • Identify any information deficiencies and seek additional information from appropriate sources
       
Element: Research claim and validate claim information
  • Check claims information to determine legitimacy of claim, including validity of policy and whether claimant is eligible to claim on policy
  • Identify needs for investigation and/or further information and appoint appropriate service providers where necessary
  • Undertake investigation and research within established claims management criteria and authorities
  • Monitor progress of investigation, if applicable
  • Refer all missing information, abnormalities or classification uncertainties to an appropriate authority
       
Element: Maintain records and lines of communication
  • Maintain regular contact with relevant parties to ensure they are aware of current status of claim and are actively participating in process
  • Communicate information promptly to underwriter, which impacts on policy
  • Maintain regular and accurate diary system, and adhere to timelines
       


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. Collect and organise information relating to claim

1.1 Obtain all relevant information to determine whether valid claim exists

1.2 Organise relevant information into coherent and valid body of case knowledge

1.3 Maintain confidentiality of information according to legislative requirements and industry principles

1.4 Identify any information deficiencies and seek additional information from appropriate sources

2. Research claim and validate claim information

2.1 Check claims information to determine legitimacy of claim, including validity of policy and whether claimant is eligible to claim on policy

2.2 Identify needs for investigation and/or further information and appoint appropriate service providers where necessary

2.3 Undertake investigation and research within established claims management criteria and authorities

2.4 Monitor progress of investigation, if applicable

2.5 Refer all missing information, abnormalities or classification uncertainties to an appropriate authority

3. Maintain records and lines of communication

3.1 Maintain regular contact with relevant parties to ensure they are aware of current status of claim and are actively participating in process

3.2 Communicate information promptly to underwriter, which impacts on policy

3.3 Maintain regular and accurate diary system, and adhere to timelines

Evidence of the ability to:

collect and organise sufficient information in an ordered format for processing the claim

effectively analyse and make decisions on the validity of the claim and refer to others where criteria is not met

communicate with the client and others as appropriate

accurately record, document and file all aspects of the claim

interpret and comply with industry and organisational obligations and objectives

assess any liabilities resulting from a claim that is beyond the insurance cover.

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:

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

identify key compliance requirements of relevant industry legislation and regulatory guidelines

outline key features of organisational information technology and communications systems relevant to analysing insurance claims

outline organisational policy, procedures, underwriting guidelines and levels of authority

describe relevant organisational products that relate to 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. Collect and organise information relating to claim

1.1 Obtain all relevant information to determine whether valid claim exists

1.2 Organise relevant information into coherent and valid body of case knowledge

1.3 Maintain confidentiality of information according to legislative requirements and industry principles

1.4 Identify any information deficiencies and seek additional information from appropriate sources

2. Research claim and validate claim information

2.1 Check claims information to determine legitimacy of claim, including validity of policy and whether claimant is eligible to claim on policy

2.2 Identify needs for investigation and/or further information and appoint appropriate service providers where necessary

2.3 Undertake investigation and research within established claims management criteria and authorities

2.4 Monitor progress of investigation, if applicable

2.5 Refer all missing information, abnormalities or classification uncertainties to an appropriate authority

3. Maintain records and lines of communication

3.1 Maintain regular contact with relevant parties to ensure they are aware of current status of claim and are actively participating in process

3.2 Communicate information promptly to underwriter, which impacts on policy

3.3 Maintain regular and accurate diary system, and adhere to timelines

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
Obtain all relevant information to determine whether valid claim exists 
Organise relevant information into coherent and valid body of case knowledge 
Maintain confidentiality of information according to legislative requirements and industry principles 
Identify any information deficiencies and seek additional information from appropriate sources 
Check claims information to determine legitimacy of claim, including validity of policy and whether claimant is eligible to claim on policy 
Identify needs for investigation and/or further information and appoint appropriate service providers where necessary 
Undertake investigation and research within established claims management criteria and authorities 
Monitor progress of investigation, if applicable 
Refer all missing information, abnormalities or classification uncertainties to an appropriate authority 
Maintain regular contact with relevant parties to ensure they are aware of current status of claim and are actively participating in process 
Communicate information promptly to underwriter, which impacts on policy 
Maintain regular and accurate diary system, and adhere to timelines 

Forms

Assessment Cover Sheet

FNSISV405 - Analyse 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

FNSISV405 - Analyse 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: