This unit applies to job roles involving insurance claims processing in a range of insurance sectors and may be applied within organisations of various sizes and across a range of customer bases.

ELEMENT

PERFORMANCE CRITERIA

1. Receive reinsurance claim

1.1. Information relating to facultative or treaty reinsurance claim is received and checked

1.2. Completeness of the information is checked

1.3. Coverage of a claim, or series of claims, under a specific client, policy or treaty is confirmed

2. Calculate the recovery including reinstatements

2.1. Amount of payment/outstanding is calculated according to organisation policy and procedures and treaty and facultative obligations

2.2. Reinsurers are notified of claim amount and details under relevant reinsurance arrangements

2.3. Payment is requested from reinsurer

2.4. Payment information is passed on to appropriate staff, where required

2.5. All claim information is accurately recorded/entered on the system

Required skills

communication skills to:

determine and confirm information, using questioning and active listening as required

relate to customers

liaise with others, share information, listen and understand

use language and concepts appropriate to cultural differences

numeracy and IT skills to:

perform calculations related to achieving required outcomes

use computer applications (word processing, spreadsheet, database, specific purpose computer systems) to assist in achieving required outcomes

access and update records electronically

access web-based information services

literacy skills to read and interpret documentation from a variety of sources and record and consolidate relevant related information

research and analysis skills for accessing and interpreting relevant information

organisational skills, including the ability to plan and sequence work

Required knowledge

relevant legislation and regulations, organisation policy, and procedures and sector policy wording

reinsurance terminology and concepts such as:

any one risk

any one event

reinstatement premium

IT and communications systems

principles and methods of filing

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:

fully comply with organisation operating procedures, legislative requirements and industry codes of practice, where applicable

comply with terms and conditions of organisation reinsurance arrangement.

Context of and specific resources for assessment

Assessment must ensure:

competency is demonstrated in the context of the 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 organisation records

access to organisation policies and procedures.

Method of assessment

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

observing processes and procedures in workplaces

verbal or written questioning on underpinning knowledge and skills

evaluating samples of work

accessing and validating third party reports.

Guidance information for assessment

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.

Facultative reinsurance may include:

reinsurance negotiated and placed on a case by case basis, as opposed to the automatic protection provided under a reinsurance treaty

each facultative reinsurance arrangement is subject to a process of offer and acceptance between parties. It is usually arranged where a type of insurance may be excluded from the terms of a treaty, where amounts insured exceed capacity, where no treaty reinsurance facility in is place, or where assessed risk is excessive and the insurer wishes to protect the results of its treaty arrangements.

Treaty reinsurance may include:

an obligatory reinsurance contract usually effected to cover the whole or a certain section of the reinsured's business with the reinsurer receiving details of each individual risk reinsured.

Claims checking may be through:

checking against facultative certificate/placing slip or cover note

checking against treaty cover note.

Organisation policies and procedures may include:

authority levels.

Entering claims data may include:

coding according to organisation requirements (entering statistical data).

Unit sector

Insurance services

This unit contains employability skills.