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

FNSISV506 Mapping and Delivery Guide
Investigate insurance claims

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency FNSISV506 - Investigate insurance claims
Description
Employability Skills
Learning Outcomes and Application This unit describes the skills and knowledge required to investigate an insurance claim. Investigation may cover the degree of liability or a potential fraud and covers clarifying the brief, conducting the investigation and reporting on the findings.It applies to individuals working in job roles involving specialist knowledge and functions including claims and 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: Clarify brief and instructions
  • Clarify brief provided to investigator including facts of claim, insurer’s instructions and outcomes required
  • Check subject matter questions to be investigated
       
Element: Investigate claim
  • Determine method of investigation
  • Collect and organise required information to make logical case
  • Carry out investigations in accordance with legislation, regulations and organisational operating procedures and codes of practice, if applicable
  • Record all data and information progressively and accurately
  • File and store securely all original documents, tapes, photographs and other material
  • Prepare and communicate appropriate changes in brief or instructions
  • Comply with any changes in brief or instructions
       
Element: Report on investigation
  • Prepare and transmit comprehensive reports according to reporting guidelines
  • Provide copies of documents, tapes, photographs and other materials to insurer’s nominated person
  • Give facts and justification for conclusions to insurer’s nominated person
  • Make recommendations for action, with appropriate justifications, where required
       


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. Clarify brief and instructions

1.1 Clarify brief provided to investigator including facts of claim, insurer’s instructions and outcomes required

1.2 Check subject matter questions to be investigated

2. Investigate claim

2.1 Determine method of investigation

2.2 Collect and organise required information to make logical case

2.3 Carry out investigations in accordance with legislation, regulations and organisational operating procedures and codes of practice, if applicable

2.4 Record all data and information progressively and accurately

2.5 File and store securely all original documents, tapes, photographs and other material

2.6 Prepare and communicate appropriate changes in brief or instructions

2.7 Comply with any changes in brief or instructions

3. Report on investigation

3.1 Prepare and transmit comprehensive reports according to reporting guidelines

3.2 Provide copies of documents, tapes, photographs and other materials to insurer’s nominated person

3.3 Give facts and justification for conclusions to insurer’s nominated person

3.4 Make recommendations for action, with appropriate justifications, where required

Evidence of the ability to:

use appropriate investigation methodologies and maintain accurate records

comply with relevant legislation and regulatory requirements in investigating a claim

produce complete and accurate investigation reports

provide detailed scoping for investigating insurance claims including in-scope and out-of-scope areas

develop options to resolve issues or problems that have the potential to impact on work outcomes during investigations.

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:

outline key requirements of industry sector legal obligations and organisational procedures in relation to investigating claims

describe and implement appropriate investigation methods including:

interviews

surveillance

internet research

document authentication

observation

identify key features of relevant legislation, regulatory guidelines and industry sector codes of practice as they apply to:

insurance contracts

consumer protection

privacy

insurance investigation

explain the importance of report writing conventions in insurance investigations.

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. Clarify brief and instructions

1.1 Clarify brief provided to investigator including facts of claim, insurer’s instructions and outcomes required

1.2 Check subject matter questions to be investigated

2. Investigate claim

2.1 Determine method of investigation

2.2 Collect and organise required information to make logical case

2.3 Carry out investigations in accordance with legislation, regulations and organisational operating procedures and codes of practice, if applicable

2.4 Record all data and information progressively and accurately

2.5 File and store securely all original documents, tapes, photographs and other material

2.6 Prepare and communicate appropriate changes in brief or instructions

2.7 Comply with any changes in brief or instructions

3. Report on investigation

3.1 Prepare and transmit comprehensive reports according to reporting guidelines

3.2 Provide copies of documents, tapes, photographs and other materials to insurer’s nominated person

3.3 Give facts and justification for conclusions to insurer’s nominated person

3.4 Make recommendations for action, with appropriate justifications, where required

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
Clarify brief provided to investigator including facts of claim, insurer’s instructions and outcomes required 
Check subject matter questions to be investigated 
Determine method of investigation 
Collect and organise required information to make logical case 
Carry out investigations in accordance with legislation, regulations and organisational operating procedures and codes of practice, if applicable 
Record all data and information progressively and accurately 
File and store securely all original documents, tapes, photographs and other material 
Prepare and communicate appropriate changes in brief or instructions 
Comply with any changes in brief or instructions 
Prepare and transmit comprehensive reports according to reporting guidelines 
Provide copies of documents, tapes, photographs and other materials to insurer’s nominated person 
Give facts and justification for conclusions to insurer’s nominated person 
Make recommendations for action, with appropriate justifications, where required 

Forms

Assessment Cover Sheet

FNSISV506 - Investigate 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

FNSISV506 - Investigate 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: