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Evidence Guide: FNSISV405 - Analyse insurance claims

Student: __________________________________________________

Signature: _________________________________________________

Tips for gathering evidence to demonstrate your skills

The important thing to remember when gathering evidence is that the more evidence the better - that is, the more evidence you gather to demonstrate your skills, the more confident an assessor can be that you have learned the skills not just at one point in time, but are continuing to apply and develop those skills (as opposed to just learning for the test!). Furthermore, one piece of evidence that you collect will not usualy demonstrate all the required criteria for a unit of competency, whereas multiple overlapping pieces of evidence will usually do the trick!

From the Wiki University

 

FNSISV405 - Analyse insurance claims

What evidence can you provide to prove your understanding of each of the following citeria?

Collect and organise information relating to claim

  1. Obtain all relevant information to determine whether valid claim exists
  2. Organise relevant information into coherent and valid body of case knowledge
  3. Maintain confidentiality of information according to legislative requirements and industry principles
  4. Identify any information deficiencies and seek additional information from appropriate sources
Obtain all relevant information to determine whether valid claim exists

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Organise relevant information into coherent and valid body of case knowledge

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Maintain confidentiality of information according to legislative requirements and industry principles

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify any information deficiencies and seek additional information from appropriate sources

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Research claim and validate claim information

  1. Check claims information to determine legitimacy of claim, including validity of policy and whether claimant is eligible to claim on policy
  2. Identify needs for investigation and/or further information and appoint appropriate service providers where necessary
  3. Undertake investigation and research within established claims management criteria and authorities
  4. Monitor progress of investigation, if applicable
  5. Refer all missing information, abnormalities or classification uncertainties to an appropriate authority
Check claims information to determine legitimacy of claim, including validity of policy and whether claimant is eligible to claim on policy

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify needs for investigation and/or further information and appoint appropriate service providers where necessary

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Undertake investigation and research within established claims management criteria and authorities

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Monitor progress of investigation, if applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Refer all missing information, abnormalities or classification uncertainties to an appropriate authority

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Maintain records and lines of communication

  1. Maintain regular contact with relevant parties to ensure they are aware of current status of claim and are actively participating in process
  2. Communicate information promptly to underwriter, which impacts on policy
  3. Maintain regular and accurate diary system, and adhere to timelines
Maintain regular contact with relevant parties to ensure they are aware of current status of claim and are actively participating in process

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Communicate information promptly to underwriter, which impacts on policy

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Maintain regular and accurate diary system, and adhere to timelines

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Collect and organise information relating to claim

1.1 Obtain all relevant information to determine whether valid claim exists

1.2 Organise relevant information into coherent and valid body of case knowledge

1.3 Maintain confidentiality of information according to legislative requirements and industry principles

1.4 Identify any information deficiencies and seek additional information from appropriate sources

2. Research claim and validate claim information

2.1 Check claims information to determine legitimacy of claim, including validity of policy and whether claimant is eligible to claim on policy

2.2 Identify needs for investigation and/or further information and appoint appropriate service providers where necessary

2.3 Undertake investigation and research within established claims management criteria and authorities

2.4 Monitor progress of investigation, if applicable

2.5 Refer all missing information, abnormalities or classification uncertainties to an appropriate authority

3. Maintain records and lines of communication

3.1 Maintain regular contact with relevant parties to ensure they are aware of current status of claim and are actively participating in process

3.2 Communicate information promptly to underwriter, which impacts on policy

3.3 Maintain regular and accurate diary system, and adhere to timelines

Required Skills and Knowledge

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Collect and organise information relating to claim

1.1 Obtain all relevant information to determine whether valid claim exists

1.2 Organise relevant information into coherent and valid body of case knowledge

1.3 Maintain confidentiality of information according to legislative requirements and industry principles

1.4 Identify any information deficiencies and seek additional information from appropriate sources

2. Research claim and validate claim information

2.1 Check claims information to determine legitimacy of claim, including validity of policy and whether claimant is eligible to claim on policy

2.2 Identify needs for investigation and/or further information and appoint appropriate service providers where necessary

2.3 Undertake investigation and research within established claims management criteria and authorities

2.4 Monitor progress of investigation, if applicable

2.5 Refer all missing information, abnormalities or classification uncertainties to an appropriate authority

3. Maintain records and lines of communication

3.1 Maintain regular contact with relevant parties to ensure they are aware of current status of claim and are actively participating in process

3.2 Communicate information promptly to underwriter, which impacts on policy

3.3 Maintain regular and accurate diary system, and adhere to timelines

Evidence of the ability to:

collect and organise sufficient information in an ordered format for processing the claim

effectively analyse and make decisions on the validity of the claim and refer to others where criteria is not met

communicate with the client and others as appropriate

accurately record, document and file all aspects of the claim

interpret and comply with industry and organisational obligations and objectives

assess any liabilities resulting from a claim that is beyond the insurance cover.

Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.

To complete the unit requirements safely and effectively, the individual must:

explain the importance of wording of insurance policies in keeping with the organisation or industry sector

identify key compliance requirements of relevant industry legislation and regulatory guidelines

outline key features of organisational information technology and communications systems relevant to analysing insurance claims

outline organisational policy, procedures, underwriting guidelines and levels of authority

describe relevant organisational products that relate to insurance claims.