Application
This unit describes the skills and knowledge required to generate and process claim related payments and required documentation in a timely manner.
It applies to individuals 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. Process payments | 1.1 Identify, check and accurately record payment information 1.2 Authorise all payments according to organisational operating procedures 1.3 Generate payments within timeframes with reference to legislation, organisational policy and operating procedures, and codes of practice if applicable 1.4 Complete payment documents and identify relevant details 1.5 Observe payment limits for amounts requiring personal signing |
2. Notify reinsurer, if appropriate | 2.1 Check reinsurance information related to claims payment 2.2 Notify reinsurers of claim payment amount and details under relevant reinsurance arrangements, where appropriate |
3. Finalise claims payment information to facilitate payment | 3.1 Finalise payment information and enter on system for prompt payment, where required 3.2 Despatch claims payment data or payments within required timeframe 3.3 Copy and file documents for auditing purposes according to organisational operating procedures 3.4 Advise interested parties according to operating procedures where liability is not accepted |
Evidence of Performance
Evidence of the ability to:
identify, collate and organise information to document payments
authorise payments within required parameters and timeframes
accurately maintain and file documentation
follow relevant legislation and organisational policies to ensure accuracy.
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 key principles and practices relevant to making claims payments
outline key features of relevant legislation, regulations, organisational operating procedures and codes of practice relating to processing claims
outline key features of taxation laws relevant to processing insurance claims
outline the conditions when reinsurers need to be informed in the claims process.
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, 1.4, 2.1 | Interprets and consolidates information and data from a range of sources, against defined criteria and requirements, and checks for accuracy and completeness |
Writing | 1.2, 1.4, 2.2, 3.1, 3.4 | Accurately records and completes organisational documents and correspondence, using clear language and correct spelling, grammar and terminology |
Oral Communication | 2.2, 3.4 | Presents complex information using vocabulary, tone and pace appropriate for the audience and purpose Uses questioning and active listening to clarify and confirm understanding |
Numeracy | 1.1, 1.3-1.5, 3.1 | Performs mathematical calculations to analyse or check financial data to accurately process payments |
Navigate the world of work | 1.2, 1.3, 3.3, 3.4 | Complies with explicit policies and procedures and legislative and regulatory requirements |
Interact with others | 2.2, 3.4 | Uses a limited range of accepted practices for communicating in a work environment |
Get the work done | 1.2, 1.3, 1.5, 2.1, 3.1, 3.2, 3.3, 3.4 | 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 solutions, and evaluates the effectiveness of the outcome Uses digital technologies to access, enter and store information required to complete work tasks |
Sectors
Insurance services