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. Evaluate status of claims portfolio

1.1. Organisation expectations for claims portfolio performance are identified

1.2. Claims portfolio data and information is analysed and evaluated to identify trends and determine status of portfolio

2. Recommend changes to claims portfolio, policy and/or procedures, as required

2.1. Changes to portfolio, policy and procedures to improve portfolio performance and minimise claims losses are identified

2.2. All changes are fully documented and records updated in compliance with organisation policies and procedures

3. Prepare status report

3.1. Accurate and timely claims portfolio reports are prepared to document status and trends where appropriate

4. Communicate findings to key stakeholders

4.1. Information which impacts on the various portfolios is communicated promptly to stakeholders according to organisation procedures

5. Review status report findings

5.1. Any feedback from stakeholders and used to review key findings and recommendations

5.2. All feedback and subsequent amendments to status report are fully documented and recorded according to organisation policies and procedures

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:

access relevant data and to update case file records

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

evaluation methodologies

industry trends in insurance portfolio management

organisation policy, procedures, underwriting guidelines and authorities

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:

apply planning, data collection, analysis, communication and report writing skills to the interpretation and evaluation of the status of a claims portfolio

interpret charts, graphs and statistical information

interpret and comply with relevant legislation, regulations and industry codes of practice.

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.

Client portfolio data and information may include:

assessor reports

case reports

correspondence to a range of medical, hospital and legal professionals on claimant related matters

database information

files

forms

insurance policy documents and coverage details

letters

minutes

telephone messages.

Stakeholders may include:

brokers or agents

claims team

managers

underwriting.

Unit sector

Insurance services

This unit contains employability skills.