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Evidence Guide: FNSISV405A - 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

 

FNSISV405A - 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. All relevant information is obtained to determine whether a valid claim exists (liability)
  2. Relevant information is organised into a coherent and valid body of case knowledge
  3. Confidentiality of information is maintained according to legislative requirements and industry principles as appropriate
  4. Any information deficiencies are identified, and additional information is sought from appropriate sources
All relevant information is obtained to determine whether a valid claim exists (liability)

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Relevant information is organised into a coherent and valid body of case knowledge

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Confidentiality of information is maintained according to legislative requirements and industry principles as appropriate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Any information deficiencies are identified, and additional information is sought from appropriate sources

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Research claim and validate claim information

  1. Claims information is checked to determine legitimacy of claim, including validity of the policy, and whether the claimant is eligible to claim on the policy
  2. Needs for investigation/further information are identified and appropriate service provider/s are appointed where necessary
  3. Information is provided to reinsurers, if applicable
  4. Investigation and research are undertaken within established claims management criteria and authorities
  5. Progress of investigation is monitored, if applicable
  6. All missing information, abnormalities or classification uncertainties are referred to an appropriate authority
Claims information is checked to determine legitimacy of claim, including validity of the policy, and whether the claimant is eligible to claim on the policy

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Needs for investigation/further information are identified and appropriate service provider/s are appointed where necessary

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Information is provided to reinsurers, if applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Investigation and research are undertaken within established claims management criteria and authorities

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Progress of investigation is monitored, if applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

All missing information, abnormalities or classification uncertainties are referred to an appropriate authority

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Maintain records and lines of communication

  1. Regular contact is maintained with the relevant parties to ensure that they are aware of the current status of the claim and are actively participating in the process
  2. Information which impacts on the policy is communicated promptly to the underwriter
  3. Diary system is maintained regularly and accurately and timelines adhered to
Regular contact is maintained with the relevant parties to ensure that they are aware of the current status of the claim and are actively participating in the process

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Information which impacts on the policy is communicated promptly to the underwriter

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Diary system is maintained regularly and accurately and timelines adhered to

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

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:

interpret and comply with industry and organisation obligations and objectives

effectively analyse and interpret data.

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.

Guidance information for assessment

Required Skills and Knowledge

Required skills

well-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

numeracy and IT skills to:

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

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

industry sector and organisation policy wording

industry sector compliance requirements

organisation IT and communications systems

organisation policy, procedures, underwriting guidelines and authorities

product knowledge

relevant common law, legal systems and procedures, relevant acts

Range Statement

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.

Liability may involve:

motor vehicle accident, dependency payments, journey/third party, pecuniary loss, loss of goods, weekly payments, medical expenses, death of a worker, claim made after worker ceases employment and others.

Service providers may include:

accountants

assessors

auditors

engineers

investigators

medical advisers

private investigators

surveyors

and others as required.

Relevant parties may include:

claims assessors

compensation authority

employer and industry associations

insurance brokers

investigators

legal service providers

medical and like providers

risk management consultants

self insurer

solicitors

the authorised insurer

the community

the customer

the employer

the worker

union

witnesses.