Application
This unit describes the skills and knowledge required to review the effectiveness of claims settlement policy and procedures, including monitoring trends in claims settlement and formulating changes to minimise losses.
It applies to individuals involved in the development and monitoring of policy and procedures associated with organisational underwriting risk within the insurance sector.
Work functions in the occupational areas where this unit may be used are subject to regulatory requirements. Refer to the FNS Implementation Guide Companion Volume or the relevant regulator for specific guidance on requirements.
Elements and Performance Criteria
ELEMENT | PERFORMANCE CRITERIA |
Elements describe the essential outcomes. | Performance criteria describe the performance needed to demonstrate achievement of the element. |
1. Collect data on claims trends | 1.1 Design and implement data gathering processes 1.2 Identify new data requirements and sources of information, and establish process for collecting data 1.3 Research industry claims settlement trends to benchmark against |
2. Monitor and report on claims trends | 2.1 Analyse data collected to identify trends 2.2 Prepare accurate and timely claims reports to document trends, where appropriate 2.3 Recommend appropriate improvements to claims settlement policy and procedures |
3. Identify required changes to portfolio, claims settlement policy or procedures | 3.1 Communicate promptly information which impacts on various portfolios to management, according to company procedures 3.2 Instigate changes to policy and procedures to minimise future losses |
Evidence of Performance
Evidence of the ability to:
effectively collect and interpret claims settlement data from a wide range of sources
thoroughly analyse the trends and the effects on claims settlement policies and procedures
document and communicate changes required in claims settlement policies and procedures.
Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.
Evidence of Knowledge
To complete the unit requirements safely and effectively, the individual must:
outline organisational policy, procedures and guidelines for claims settlement
outline data collection design and practice
outline data analysis techniques relating to claims settlement
describe industry trends in insurance prudential risk management
explain portfolio management techniques in insurance prudential risk management
analyse reasons for losses as a result of poor claims settlement policy and procedures, and recommend improvements to avoid recurrence.
Assessment Conditions
Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance services field of work and include access to:
organisational records
organisational policy, procedures, legislation and regulations as they relate to contracts of insurance
a range of common technology and software.
Assessors must satisfy NVR/AQTF assessor requirements.
Foundation Skills
This section describes language, literacy, numeracy and employment skills incorporated in the performance criteria that are required for competent performance.
Skill | Performance Criteria | Description |
Reading | 1.1, 1.2, 1.3, 2.1 | Critically analyses complex documentation from a variety of sources and consolidates information relating to specific criteria to determine requirements |
Writing | 1.1, 2.2, 2.3, 3.1 | Accurately records information and prepares correspondence and documentation using clear language and organisational formats and protocols Composes, edits and proofreads reports to ensure clarity of meaning, and accuracy and consistency of information |
Oral Communication | 3.1 | Clearly explains detailed information using language, tone and pace appropriate to the audience |
Numeracy | 2.1 | Performs mathematical calculations to analyse information, costs and values to accurately determine trends |
Navigate the world of work | 1.2, 3.1, 3.2 | Seeks to improve policies and procedures to better meet organisational goals Identifies and resolves key business issues, processes and practices that may have legal implications Follows policies, procedures and legislative requirements and identifies organisational implications of new legislation or regulation |
Interact with others | 2.3, 3.1 | Selects, implements and seeks to improve protocols governing communications to clients and co-workers in a range of work contexts |
Get the work done | 1.1, 1.2, 1.3, 2.2, 2.3, 3.2 | Plans and sequences complex tasks and workload, negotiating key aspects with others and taking into account capabilities, efficiencies and effectiveness Applies systematic and analytical decision-making processes for complex and non-routine situations Investigates new and innovative ideas as a means to continuously improve work practices and processes through consultation, formal and analytical thinking Uses digital technologies to access, enter, check and store information required to complete work tasks |
Sectors
Insurance services