Application
This unit describes the skills and knowledge required to provide an insurance claims service to clients in an insurance broking context.
The unit applies to those who use well-developed communication and interpersonal skills in insurance broking 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. Users are advised to check with the relevant state and territory regulatory authorities to confirm those requirements.
Elements and Performance Criteria
1. Register claim | 1.1 Use internal broking claims system to register and process client claims 1.2 Update claims recording system in a manner that minimises processing time and according to organisational policies and procedures |
2. Advise insurers and complete required documentation | 2.1 Verify appointment of loss adjuster on receipt of claim 2.2 Obtain formal acknowledgment of receipt of claim from insurers 2.3 Make formal claim reports according to organisational procedures and within brokerage time requirements 2.4 Provide assistance to client, when required to complete claim documentation according to codes of practice 2.5 Ensure full and accurate information is available to insurers in assessing claim |
3. Advise client of rights and obligations | 3.1 Formally request insurer to reinstate sum insured where required and inform client where reinstatement occurs 3.2 Review terms and conditions of insurance policy with client to ensure maximum claim recovery is sought 3.3 Advise client on administration of claims to ensure no breach of contract occurs and claims are managed efficiently 3.4 Advise client of legislative requirements to protect client interests |
4. Liaise with service providers | 4.1 Identify need for independent service providers with suitable expertise for claim, where settlement authority exists 4.2 Engage suitable service provider based on client instructions where settlement authority exists and according to organisational policies and procedures 4.3 Brief service provider thoroughly to ensure investigation is comprehensive where settlement authority exists 4.4 Review and assess service provider’s report within agreed timeframes where settlement authority exists 4.5 Maintain contact with insurer’s service provider to ensure reports and issues are dealt with within required timeframe |
5. Notify terms of settlement to client and update files and records | 5.1 Prepare details of insurer’s settlement offer without delay, with recommendations for client to review 5.2 Obtain and act on client’s response to settlement offer without delay and according to organisational procedures 5.3 Remit settlement funds to client according to legislative requirements and organisational policies and procedures 5.4 Update business records promptly according to organisational policies and procedures |
Evidence of Performance
The candidate must demonstrate the ability to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including evidence of the ability to:
provide a claims service to at least two different insurance broking clients.
Evidence of Knowledge
The candidate must be able to demonstrate knowledge to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including knowledge of:
legislative compliance requirements and codes of practice relating to adviser dealing with client claims
organisational policies and procedures, including for:
establishing client insurance requirements and covers
notifying insurer of claims-related information
assisting client in completing required documentation and declarations
using brokerage claims systems and procedures
finalising client documentation and declarations
engaging external service providers
remitting funds
responsibilities of adviser in claims process
processes for analysing insurance contract terms and conditions in relation to claims process and administering claims
key components of broking claim systems and claim documentation
common terms and conditions in brokerage insurance policies.
Assessment Conditions
Skills in this unit must be demonstrated in a workplace or simulated environment where the conditions are typical of those in a working environment in this industry.
This includes access to:
organisational equipment, technology, software and consumables
organisational records
organisational policies and procedures.
Assessors of this unit must satisfy the requirements for assessors in applicable vocational education and training legislation, frameworks and/or standards.
Foundation Skills
Numeracy | Checks calculations to confirm insurance requirements and settlements Plans and schedules to manage timeframes |
Oral communication | Uses language suitable to audience and purpose to convey requirements Uses active listening and questioning techniques to confirm understanding |
Reading | Interprets information from a range of sources and identifies key information |
Writing | Records and completes organisational documentation and correspondence using language appropriate to audience and purpose, and correct spelling, grammar and terminology Writes, edits and proofreads documents to ensure clarity of meaning, and accuracy and consistency of information |
Planning and organising | Plans, sequences and prioritises tasks and own workload to achieve organisational requirements Takes responsibility for planning, organising, implementing and reviewing systems to manage sensitive information |
Self-management | Follows legislative requirements, and organisational policies and procedures, and meets expectations of own role Implements strategies to establish a sense of connection and build rapport with clients |
Teamwork | Uses collaboration techniques to negotiate agreed outcomes Selects and uses appropriate conventions and protocols when communicating with clients, insurers and service providers in a range of contexts |
Technology | Uses digital technologies to access, enter and store information |
Sectors
Insurance broking