This unit applies to job roles involving settling claims 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. Calculate claim entitlement

1.1. Information is gathered and evaluated to determine the amount of loss suffered by the customer

1.2. Settlement terms are determined according to policy wording, legislation and codes of practice

2. Negotiate and communicate settlement terms

2.1. Terms and conditions of settlement offer are promptly advised to client and/or third party according to organisation claims procedures, where appropriate

2.2. Response by client and/or third party to terms of settlement offer is considered to assess whether adjustment is required to take into account the value of lost or damaged goods

2.3. Negotiation is undertaken in an endeavour to reach mutual agreement on valuation

2.4. Terms and conditions of settlement offer are modified as necessary and client and/or third party advised promptly

3. Document liability decisions

3.1. Claim decisions are clearly communicated to the relevant parties in a manner required by the policy wording, the legislation, organisation operating procedures and codes of practice

3.2. Decisions are documented in such a way as to determine the basis on which the decision was reached and all the evidence/information that was considered, where applicable

3.3. Claims documentation is sent to reinsurers

4. Finalise settlement

4.1. Once settlement is reached, payments are made/instructed within the required timeframe

4.2. Settlement release is obtained from client and/or third party, as applicable

4.3. Claim referred for recovery action if appropriate, and loss recovery agent appointed if applicable

4.4. Recovery action is initiated from reinsurers if applicable

4.5. Finalised claims files are stored and maintained according to organisation policy and legislative requirements and codes of practice, as applicable

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

accountability requirements

level at which claim should be referred to senior staff

organisation philosophy, policy and procedures

policy coverage

relevant industry legislation

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:

apply organisation policy and procedures and comply with legislation and regulations and industry codes of practice.

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.

Customer may be:

a third party

an agent or a lawyer acting for the client

the client.

Settlement terms may include:

cash settle

ex gratia payments

repair

replace

total loss

vouchers.

Claim decisions may be:

cancellation of claim (excess greater than settlement)

need further details

partial settlement

payment

repair approval

replacement approval.

Recovery action may include:

determining financial status of third party

determining liability of third party

recovery from reinsurers

salvage.

Storage of data may be:

electronic or hard copy (paper).

Unit sector

Insurance services

This unit contains employability skills.