This unit applies to claims and underwriting job roles involving specialist knowledge and functions 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 analyse data on claims trends

1.1. Data gathering processes are designed and implemented

1.2. New data requirements and sources are identified and process for collecting the data established

1.3. Data collected is analysed to identify trends and trends are documented

2. Monitor claims trends

2.1. Accurate and timely claims reports are prepared to document trends and identify issues where appropriate

2.2. Relevant information which impacts on a client portfolio is communicated promptly to management according to organisation procedures

3. Identify opportunities to improve client outcomes

3.1. Assist clients identify changes to policies and procedures to improve occupational health and safety and return to work practices and minimise claims costs in similar circumstances

3.2. Advice to clients is communicated effectively promoting positive action

3.3. Sources of advice are provided to client 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 computer applications (word processing, spreadsheet, database, specific purpose computer systems) to undertake analysis and generate reports

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

claims policies and procedures

data analysis techniques

industry trends in claims handling

type of claims events and possible remediation strategies

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:

collect and interpret data from a wide range of sources and analyse the causes of trends and the effects on claims history, settlement policies and procedures

prepare advice and recommendations for suitable actions.

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.

Data may include:

claim statistic reports

claims history

claims reports

costs

declinature claims

frequency of events

inter-disciplinary rehabilitation (IDR) referrals

occupational health and safety reports

surveys

type of events.

Sources of information may include:

occupational health and safety (OHS) reports

previous policies and historical documents

reports on claims

surveys.

Documentation may include:

claims frequency

claims settlement costs

loss ratios

premium calculations/income

premium income

reports on claims

surveys.

Relevant information may include:

changes to type of business conducted

claims impact on client policy premiums

client operating conditions

client organisation or organisational structure or financial arrangements

industry trends, regulations

internal or external factors impacting premiums

legislative, industry or economic changes.

Changes may include:

OHS and environmental practices

organisation processes and procedures

relevant return to work, health strategies.

Sources of advice may include:

industry consultants

industry specialists

OHS and Return to Work specialists

specialist brokers.

Unit sector

Insurance services

This unit contains employability skills.