Application
This unit describes the skills and knowledge required to process facultative and treaty reinsurance claims in accordance with organisational guidelines and procedures.
It applies to individuals employed in a range of insurance sectors within organisations of various sizes and across a range of customer bases who apply systematic approaches to processing non-routine claims.
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 reinsurance claim | 1.1 Receive and check information relating to facultative or treaty reinsurance claim 1.2 Check completeness of information 1.3 Confirm coverage of a claim, or series of claims, under specific customer, policy or treaty |
2. Calculate recovery, including reinstatements | 2.1 Calculate payment amount or amount outstanding according to organisational policy and procedures, and treaty and facultative obligations 2.2 Notify reinsurers of claim amount and details under relevant reinsurance arrangements 2.3 Request payment from reinsurer 2.4 Pass payment information on to appropriate staff, where required 2.5 Accurately record or enter on the system all claim information |
Evidence of Performance
Evidence of the ability to:
accurately process facultative and treaty reinsurance claims across a representative range of products, customers and conditions by:
receiving, recording and clarifying the reinsurance claim information
notifying the customer of claim and payment outcomes
documenting and communicating outcomes to the reinsurer
calculate payments within facultative and reinsurance arrangements.
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:
describe the difference between facultative and treaty reinsurance
outline key features of relevant legislation, regulations and organisational policy and procedures for processing facultative and treaty reinsurance claims
interpret key wording used in policies relating to facultative and treaty reinsurance
explain reinsurance terminology and concepts such as:
any one risk
any one event
reinstatement premium
outline principles and methods of filing and storing documentation
outline terms and conditions of reinsurance arrangements between insurers and reinsurers.
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
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 | 1.1, 1.2, 1.3 | Analyses and consolidates information and data from a range of sources, against defined criteria and requirements, and checks for accuracy and completeness |
Writing | 2.2, 2.3, 2.4, 2.5 | Accurately records information and prepares correspondence and documentation using clear language and organisational formats and protocols |
Oral Communication | 2.2, 2.3, 2.4 | Effectively participates in verbal exchanges using collaborative and inclusive techniques including active listening and questioning to convey and clarify information |
Numeracy | 1.1, 1.2, 2.1 | Performs mathematical calculations to check financial data and to accurately process claims |
Navigate the world of work | 2.1 | Complies with explicit policies and procedures |
Interact with others | 2.2-2.4 | Uses a limited range of accepted practices for communicating in a work environment |
Get the work done | 1.1, 1.2, 1.3, 2.4 | Plans and implements routine tasks and workload, making limited decisions on sequencing, timing and collaboration, and seeking assistance in setting priorities Responds to predictable routine problems and implements standard or logical solutions Uses digital technologies to access, enter and store information required to complete work tasks |
Reading | 1.1, 1.2, 1.3 | Analyses and consolidates information and data from a range of sources, against defined criteria and requirements, and checks for accuracy and completeness |
Sectors
Insurance services