FNSSUP407
Assess complex superannuation benefit or insurance claims


Application

This unit describes the skills and knowledge required to assess complex superannuation benefits and/or insurance claims. Conditions would include claims for death, total and permanent disability (TPD), income protection, terminal illness payment and situations of severe financial hardship.

It applies to individuals who use specialised industry knowledge and analytical skills to evaluate and process complex information and data following defined procedures.

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. Review validity of request

1.1 Review validity of request for payment against fund entitlements within operating guidelines, operational authorities and legislative guidelines

1.2 Undertake review in methodical manner, using suitable checklist or similar instruments to ensure accuracy

2. Review documentation and evidence

2.1 Establish payment criteria to enable compliance to be determined within terms and conditions of trust, relevant legislation and operating guidelines

2.2 Obtain additional evidence where required from appropriate parties to confirm that request complies with fund’s conditions of entitlement

3. Determine entitlement and communicate decision

3.1 Determine level of entitlement based on accurate and complete information

3.2 Determine entitlements within authority levels and obtain sign-off where required

3.3 Make decision on payment in accordance with trustee instruction, operating guidelines and relevant legislation

3.4 Communicate decision according to organisational policy and procedures to relevant parties

Evidence of Performance

Evidence of the ability to:

review validity of requests and related documentation and evidence

determine entitlements according to organisational authority levels, fund entitlements and operating guidelines

follow appropriate payment criteria according to the terms and conditions of the trust deed, relevant legislation and organisational 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:

describe the key features of relevant legislation relating to superannuation

outline the organisational authority levels

explain the key aspects of fund entitlements and operating guidelines

identify appropriate payment criteria according to relevant trust deed, legislation or organisational procedure

explain the application of fund policies and procedures on the assessment of superannuation benefit or insurance claims

outline recent changes to products and services, and implications for assessments.


Assessment Conditions

Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the superannuation field of work and include access to:

common office equipment, technology, software and consumables

organisational financial records

organisational policy and procedures.

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, 2.1, 2.2, 3.1

Researches and consolidates complex information and data from a range of sources

Thoroughly analyses information and data against defined criteria, conditions and requirements

Writing

1.2, 2.2, 3.4

Accurately records information and prepares organisational documents and correspondence using language, concepts and terminology appropriate for the audience

Oral Communication

2.2, 3.2, 4.1

Participates effectively in verbal exchanges, using active listening and questioning to share, convey and clarify information with a range of people

Numeracy

2.1, 3.1-3.3

Performs calculations and uses a range of mathematical problem-solving techniques to analyse complex financial data and requirements

Navigate the world of work

1.1, 2.1, 3.3, 3.4

Takes personal responsibility for following explicit and implicit policies, procedures and legislative requirements

Interact with others

2.2, 3.2, 4.1

Identifies and explores differences in a diverse range of people in the work context and makes adjustments to communication in recognition of these differences

Selects and uses appropriate conventions and protocols when communicating with clients and others in a range of work contexts

Get the work done

1.1, 1.2, 2.1, 2.2, 3.1-3.3

Takes responsibility for planning, sequencing and prioritising tasks and own workload for efficiency and effective outcomes

Makes routine decisions and implements standard procedures for routine tasks

Applies systematic and analytical decision-making processes for complex and non-routine situations

Uses a range of digitally based technologies to enter, access or update information to achieve required outcomes


Sectors

Superannuation