This unit applies to job roles involving specialist knowledge and functions including claims and underwriting 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. Clarify the brief and the instructions

1.1. The brief provided to the investigator is clarified including the facts of the claim, the insurer's instructions and outcomes required

1.2. The subject matter questions to be investigated are checked

2. Investigate claim

2.1. Method of investigation is determined

2.2. Required information is collected and organised to make a logical case

2.3. Investigations are carried out in accordance with legislation, regulations and organisation operating procedures and codes of practice, if applicable

2.4. All data and information is recorded progressively and accurately

2.5. All original documents, tapes, photographs and other material are filed and stored securely

2.6. Appropriate changes in the brief or instructions are prepared and communicated

2.7. Any changes in the brief or the instructions are complied with

3. Report on the investigation

3.1. Comprehensive reports are prepared and transmitted according to reporting guidelines

3.2. Copies of the documents, tapes, photographs and other materials are provided to the insurer's nominated person

3.3. Facts and justification for conclusions are given to the insurer's nominated person

3.4. Recommendations for action are made, with appropriate justifications, where required

Required skills

highly 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

well-developed numeracy and IT skills to:

perform calculations related to achieving required outcomes

use investigative tools such as cameras, recorders

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

learning skills to maintain knowledge of changes to compliance legislation and requirements

problem solving skills to identify any issues that have the potential to impact on work outcomes and to develop options to resolve these issues when they arise

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

appropriate investigation methods including:

interviews

surveillance

internet research

how to establish the authenticity of document

observation

industry codes of practice

organisation policy and procedures

relevant legislation and regulations particularly the Privacy Act

report writing conventions

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 relevant legislation and regulatory requirements

implement investigation methodologies

apply comprehensive understanding of the industry sector and all legal obligations and organisation procedures in relation to investigating claims

produce complete and accurate investigation reports.

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

setting and reviewing workplace projects and business simulations or scenarios.

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.

The brief may include:

claims history

information provided by the customer

witness statements.

Subject matter may include:

corporations

evidence

incidents

individuals

locations

objects

processes

statements.

Methods of investigation may include:

interviews

mechanical or chemical analysis

observation

phone calls

review of documents

other relevant information gathering activities.

Investigations may include:

corroboration or analysis of subject matter

determining causes or sequence of events

extent of liability

identification of subject matter

suspected or potential fraud

validation of evidence

other actual or potential problems.

Data and information collected may include:

audio and video tapes

documents

electronic records

photographs

subject matter and other relevant materials.

Comprehensive reports may include:

findings

photos

recommendations

witness statements.

Reporting guidelines may include:

areas to be excluded

attachments and evidence

frequency and number of reports

level of detail

limits and types of enclosures

methods of transmission

structure of reports and number copies

topics to be covered.

The nominated person may include:

the person monitoring the investigation on behalf of the organisation.

Unit sector

Insurance services

This unit contains employability skills.