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

FNSISV517A Mapping and Delivery Guide
Review claims settlement policies and procedures

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency FNSISV517A - Review claims settlement policies and procedures
Description This unit describes the skills needed to review the effectiveness of claims settlement policies and procedures including monitoring trends in claims settlement and formulating changes to minimise losses.
Employability Skills This unit contains employability skills.
Learning Outcomes and Application This unit applies to those involved in the development and monitoring of policies and procedures associated with organisational underwriting risk within the insurance sector.
Duration and Setting X weeks, nominally xx hours, delivered in a classroom/online/blended learning setting.
Prerequisites/co-requisites Not applicable.
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 data on claims trends
  • Data gathering processes are designed and implemented
  • New data requirements and sources of information are identified and process for collecting the data established
       
Element: Monitor and report on claims trends
  • Data collected is analysed to identify trends
  • Accurate and timely claims reports are prepared to document trends where appropriate
       
Element: Identify required changes to portfolio, claims settlement policy or procedures
  • Information which impacts on the various portfolios is communicated promptly to management according to company procedures
  • Changes to policy and procedures are instigated to minimise future losses
       


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:

collect and interpret data from a wide range of sources

analyse the causes of trends and the effects on claims settlement policies and procedures.

Context of and specific resources for assessment

Assessment must ensure:

competency is demonstrated in the context of the financial services 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 financial services product information

access to information about workplace policy and procedures.

Method of assessment

A range of assessment methods should be used to assess practical skills and knowledge. The following examples 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

simulated tasks involving preparation of reports from supplied data

verbal or written questioning on underpinning knowledge and skills

evaluating samples of work.

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:

liaise and share information with others

gather and check information

IT skills to:

use computer applications (word processing, spreadsheet, database, specific purpose computer systems)

access and update records electronically

access web-based information services

numeracy skills to:

interpret numeric data and relevant statistics relative to claims and prudential risk

undertake trend analysis

perform portfolio analysis

organisational skills to efficiently plan and sequence work

reading skills to:

read and understand relevant procedures

read and understand reports and statistics

research and analysis skills to:

identify and interpret relevant information

analyse information and data

interpret statistics

writing skills to:

accurately record information

appropriately reference source documents including policy definitions and submitted evidentiary documents

prepare reports

draft policy documents.

Required knowledge

claims policies and procedures

data analysis techniques

industry trends in insurance prudential risk management

portfolio management techniques in insurance prudential risk management

design and practice in data collection.

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.

Sources of information may include:

reports on claims

declinature claims

inter-disciplinary rehabilitation (IDR) referrals

claim statistic reports

previous policies and historical documents

premium income

claims settlement costs

loss ratios

claims frequency

surveys.

Claims reports may include:

loss ratios

claims settlement costs

claims frequencies.

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
Data gathering processes are designed and implemented 
New data requirements and sources of information are identified and process for collecting the data established 
Data collected is analysed to identify trends 
Accurate and timely claims reports are prepared to document trends where appropriate 
Information which impacts on the various portfolios is communicated promptly to management according to company procedures 
Changes to policy and procedures are instigated to minimise future losses 

Forms

Assessment Cover Sheet

FNSISV517A - Review claims settlement policies and procedures
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

FNSISV517A - Review claims settlement policies and procedures

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: