Application
This unit describes the skills and knowledge required to receive and record or register claims, including gathering the information, initial estimation and entering the claim into organisational records.
It applies to individuals who work in job roles involving insurance claims in a range of insurance sectors and may be applied within 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. Refer to the FNS Implementation Guide Companion Volume or the relevant regulator for specific guidance on requirements.
Elements and Performance Criteria
ELEMENT | PERFORMANCE CRITERIA |
Elements describe the essential outcomes. | Performance criteria describe the performance needed to demonstrate achievement of the element. |
1. Receive notification of claim | 1.1 Advise customer of claims procedure 1.2 Give customer comprehensive information on organisation’s claims procedure, how to make a claim and send any forms required for claim to customer 1.3 Answer customer queries clearly and accurately |
2. Receive claim | 2.1 Check new claims advice to verify correct policy detail 2.2 Check claims records to ensure that claim has not been registered previously |
3. Record or register claim | 3.1 Accurately enter claims data and register claims in accordance with organisational procedures and level of authority 3.2 Notify government authorities in correct format, where necessary |
4. Estimate claims reserve, including reinsurance as appropriate | 4.1 Calculate or estimate where appropriate the preliminary reserve according to organisational reserving policy 4.2 For a routine claim, make a determination on acceptance or referral of claim in accordance with organisational policy and procedures 4.3 Identify need for internal or external service providers, if appropriate 4.4 Check policy for reinsurance details, if applicable 4.5 Advise reinsurers of potential claim, if applicable, by raising reinsurance advice 4.6 Report potential impact of claim on premium as required |
5. Create claim files or add information to existing files | 5.1 File correspondence in correct claims files and allocate to relevant claims operatives 5.2 Refer all missing information, abnormalities or classification uncertainties according to organisational policy 5.3 Enter appropriate date into diary system, where necessary 5.4 Complete all information accurately and clearly, and in accordance with legislative and organisational requirements 5.5 File or refer completed documentation for processing if appropriate |
Evidence of Performance
Evidence of the ability to:
obtain claim information from customer and check details
record claims following relevant organisational operating procedures, legislative requirements and industry codes of practice
prepare claim costing and confirm its compliance with policies and procedures
complete documentation and data entry, ensuring accuracy, attention to detail and thorough checking
communicate outcome of claims with customer and others as appropriate
record and file relevant documentation and information.
Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.
Evidence of Knowledge
To complete the unit requirements safely and effectively, the individual must:
explain the information technology and communications systems used in processing insurance claims
explain the wording of insurance policies in terms of organisational and departmental policy, procedures and authorities
explain the purpose, principles and methods of filing documentation
identify and describe the organisation’s insurance products available to customers, including any conditions and terms of reinsurance
outline relevant legislation, regulations, organisational policy and procedures for underwriting and levels of authority
explain the basics of reinsurance with respect to claims.
Assessment Conditions
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
an appropriate work environment and conditions.
Assessors must satisfy NVR/AQTF assessor requirements.
Foundation Skills
This section describes language, literacy, numeracy and employment skills incorporated in the performance criteria that are required for competent performance.
Skill | Performance Criteria | Description |
Reading | 2.1, 2.2, 4.4 | Evaluates information from a variety of sources to ensure appropriateness to customer needs Consolidates information and data from a range of sources, against defined criteria and requirements, and checks for accuracy and completeness |
Writing | 1.1, 1.2, 1.3, 3.1, 3.2, 4.5, 4.6, 5.3, 5.4 | Accurately records and completes organisational documents and correspondence using clear language and correct spelling, grammar and terminology |
Oral Communication | 1.1, 1.3, 3.2, 4.6 | Conveys information effectively to a range of personnel using active listening and questioning to clarify understanding |
Numeracy | 4.1 | Performs mathematical calculations to analyse financial data and statistics, and to accurately process claims |
Navigate the world of work | 3.1, 3.2, 4.1, 4.2, 5.2, 5.4 | Complies with legal and regulatory requirements and explicit policies and procedures |
Interact with others | 1.1, 1.3, 4.3, 4.6, 5.1, 5.2, 5.5 | Identifies and takes steps to follow accepted communication practices and protocols Recognises common cultural and other differences of people in the work context and makes adjustments in addressing the differences |
Get the work done | 1.2, 2.1, 2.2, 3.1, 4.2, 4.3, 4.5, 4.6, 5.1, 5.5 | Plans and implements routine tasks and workload, making limited decisions on sequencing, timing and collaboration, and seeking assistance in setting priorities Makes low-impact decisions within familiar situations, based on a range of predefined or routine processes Responds to predictable routine problems by implementing standard or logical solutions Uses digital technologies to access, enter and store information required to complete work tasks |
Sectors
Insurance services