This unit applies to underwriting or claims job roles 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. Collect and organise information relating to claim

1.1. All relevant information is obtained to determine whether a valid claim exists (liability)

1.2. Relevant information is organised into a coherent and valid body of case knowledge

1.3. Confidentiality of information is maintained according to legislative requirements and industry principles as appropriate

1.4. Any information deficiencies are identified, and additional information is sought from appropriate sources

2. Research claim and validate claim information

2.1. Claims information is checked to determine legitimacy of claim, including validity of the policy, and whether the claimant is eligible to claim on the policy

2.2. Needs for investigation/further information are identified and appropriate service provider/s are appointed where necessary

2.3. Information is provided to reinsurers, if applicable

2.4. Investigation and research are undertaken within established claims management criteria and authorities

2.5. Progress of investigation is monitored, if applicable

2.6. All missing information, abnormalities or classification uncertainties are referred to an appropriate authority

3. Maintain records and lines of communication

3.1. Regular contact is maintained with the relevant parties to ensure that they are aware of the current status of the claim and are actively participating in the process

3.2. Information which impacts on the policy is communicated promptly to the underwriter

3.3. Diary system is maintained regularly and accurately and timelines adhered to

Required skills

well-developed communication skills to:

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

relate effectively 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

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

self-management skills for complying with ethical, legal and procedural requirements research and analysis skills for accessing and interpreting relevant information

organisational skills, including the ability to plan and sequence work

Required knowledge

industry sector and organisation policy wording

industry sector compliance requirements

organisation IT and communications systems

organisation policy, procedures, underwriting guidelines and authorities

product knowledge

relevant common law, legal systems and procedures, relevant acts

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:

interpret and comply with industry and organisation obligations and objectives

effectively analyse and interpret data.

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.

Liability may involve:

motor vehicle accident, dependency payments, journey/third party, pecuniary loss, loss of goods, weekly payments, medical expenses, death of a worker, claim made after worker ceases employment and others.

Service providers may include:

accountants

assessors

auditors

engineers

investigators

medical advisers

private investigators

surveyors

and others as required.

Relevant parties may include:

claims assessors

compensation authority

employer and industry associations

insurance brokers

investigators

legal service providers

medical and like providers

risk management consultants

self insurer

solicitors

the authorised insurer

the community

the customer

the employer

the worker

union

witnesses.

Unit sector

Insurance services

This unit contains employability skills.