This unit applies to claims management 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. Review claims reserves

1.1. Claims reserves are regularly reviewed to ensure they accurately reflect expectations

1.2. Accurate data is provided to assist underwriters to identify and charge appropriate policy premiums

2. Monitor funds

2.1. Funds are monitored to ensure adequate reserves exist to pay claims as they fall due for payment

3. Support claims staff in claims reserve activities

3.1. Claims coordination staff are supported, as required, to identify accurate initial claims reserves

3.2. Claims coordination staff are supported, as required, in allocation of claim to appropriate claims specialists

4. Authorise payments, settlements and changes to reserves

4.1. Payments, settlements and reserves changes are authorised as requested by claims specialists that are outside their delegated authority, as required

5. Identify required changes to portfolio, claims reserves policy or procedures

5.1. Identified information is communicated promptly to decision makers in the management structure according to organisation procedures

5.2. Changes to policy and procedures are instigated to minimise claims losses in similar circumstances

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:

interpret charts, graphs and statistical information

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

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

data analysis techniques

industry trends in claims reserving policy and procedures

information technology and communications systems

organisation policy, procedures, underwriting guidelines and authorities

policy coverage requirements and wording

reinsurance processes

relevant industry compliance requirements, legislation and industry codes of practice

risk prevention and loss minimisation methods and application

types and categories of insurance policies

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:

undertake high level data collection, analysis and monitoring skills

apply communication skills related to the review, update and reporting of claims reserves in an insurance claims portfolio

interpret and comply with relevant legislation and claims/reserves trends thorough understanding of the industry and organisation obligations and objectives.

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.

Claims reserves data may be gathered from:

claims frequency

claims reserving policies, trends, data

claims settlement costs

claims specialists and other relevant staff

loss ratios

portfolio reporting data and historical information

reports on claims

surveys.

Accurate data may include:

claim statistic reports

premium reports

surveys

other relevant materials.

Decision making activities may include:

consultation

fact finding

research.

Unit sector

Insurance services

This unit contains employability skills.