Application
This unit describes the skills and knowledge required to manage liaison with insurance bodies. It involves establishing insurer liaison, supervising the claim procedures, managing complex claims and managing risk.
The unit applies to those working in superannuation organisations who use analytical skills and systematic approaches to liaise with insurance bodies and oversee specific organisational processes.
No licensing, legislative or certification requirements apply to this unit at the time of publication.
Elements and Performance Criteria
1. Establish insurer liaison | 1.1 Identify organisational procedures for insurance arrangements 1.2 Determine insurance performance measures 1.3 Establish contact with insurer and maintain liaison 1.4 Determine insurance premium payment details 1.5 Establish procedures for processing claims 1.6 Obtain paperwork required to undertake insurer liaison activities 1.7 Provide insurer with information to maintain member records |
2. Manage risk | 2.1 Assess risk profile of member with insurer 2.2 Undertake procedures to reduce risk according to organisational policies and procedures 2.3 Assess claims documentation and generate reports for trustee 2.4 Implement trustee decisions on claims and risk management procedures |
3. Supervise claim procedures | 3.1 Monitor performance requirements for insurer 3.2 Provide insurer with information as required to process claims 3.3 Refer disputed claims to complaints procedure |
4. Manage complex insurance claims | 4.1 Gather documentation for complex claims and prepare for insurer 4.2 Check claim applications against relevant terms in trust deed 4.3 Incorporate claim beneficiaries into claims processing procedure 4.4 Compile claim correspondence according to conditions identified in trust deed, relevant legislation and organisational policies and procedures 4.5 Forward claim correspondence to insurer |
Evidence of Performance
The candidate must demonstrate the ability to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including evidence of the ability to:
manage insurer liaison on at least three occasions.
In the course of the above, the candidate must:
maintain documentation systems for insurance claims
identify, source and interpret required information to process benefits for lump sum payments, death claims and disablement claims.
Evidence of Knowledge
The candidate must be able to demonstrate knowledge to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including knowledge of:
organisational policies, procedures, objectives and guidelines relating to insurance arrangements and performance measures, including for:
calculating and processing benefits
assessing insurance claims, and calculating and processing benefit payments
documentation requirements for processing death and disability payments
applying regulations and legislation to payments
key steps in internal and external complaints processes in superannuation
compliance responsibilities for claims processing
tendering processes
organisation’s risk management strategies.
Assessment Conditions
Skills in this unit must be demonstrated in a workplace or simulated environment where the conditions are typical of those in a working environment in this industry.
This includes access to:
organisational equipment, technology, software and consumables
organisational policies and procedures.
Assessors of this unit must satisfy the requirements for assessors in applicable vocational education and training legislation, frameworks and/or standards.
Foundation Skills
Numeracy | Applies mathematical problem-solving techniques to analyse and assess numerical and financial data, and to process claims |
Oral communication | Uses active listening and questioning techniques to negotiate outcomes, and to convey and clarify information in verbal exchanges |
Reading | Sources and consolidates complex information and data from a range of sources Thoroughly analyses information and data against defined criteria, conditions and requirements |
Writing | Logically records and manages information using correct organisational formats and systems Prepares documentation using clear language, concepts and terminology appropriate to audience and purpose |
Problem solving | Accepts responsibility for addressing less predictable problems and applies problem-solving processes to determine a solution Makes critical decisions effectively in complex situations, taking into consideration a range of variables, including the outcomes of previous decisions Identifies and resolves key business issues, processes and practices that may have legal implications |
Self-management | Accepts responsibility for planning and sequencing complex tasks and workload, negotiating key aspects with others and taking into account capabilities, efficiencies and effectiveness Takes responsibility for following policies, procedures and legislative requirements, and identifies organisational implications of new legislation or regulations |
Teamwork | Implements strategies for a diverse range of colleagues and clients to build rapport and foster strong relationships Uses collaboration techniques to share information conducive to a productive environment |
Technology | Uses digitally based technologies to enter, access or update information to achieve required outcomes |
Sectors
Superannuation