Manage non-routine and complex claims Evidence Guide

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Evidence Guide: FNSISV510A - Manage non-routine and complex 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

FNSISV510A - Manage non-routine and complex claims

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

Analyse claim to determine validity

Validity of claim is assessed against organisation and policy acceptance criteria for relevant type and category of policy
Information is confirmed as accurate, comprehensive and authentic
Inclusive validity is sought from specialists for advice where required
Reinsurer is notified of any claim immediately

Validity of claim is assessed against organisation and policy acceptance criteria for relevant type and category of policy

Completed
Date:

Teacher:

Evidence:

Information is confirmed as accurate, comprehensive and authentic

Completed
Date:

Teacher:

Evidence:

Inclusive validity is sought from specialists for advice where required

Completed
Date:

Teacher:

Evidence:

Reinsurer is notified of any claim immediately

Completed
Date:

Teacher:

Evidence:

Evaluate the impact of a claim

Data relating to the extent of the loss, damage or injury situation is analysed and claim estimates sought and reviewed
Claim is compared to expected payment projections for the product type, and business impact is determined
Strategies to minimise negative impact of any non-routine/complex claim are determined within requirements to meet policy obligations
Necessity for urgent action to protect organisation interests is determined

Data relating to the extent of the loss, damage or injury situation is analysed and claim estimates sought and reviewed

Completed
Date:

Teacher:

Evidence:

Claim is compared to expected payment projections for the product type, and business impact is determined

Completed
Date:

Teacher:

Evidence:

Strategies to minimise negative impact of any non-routine/complex claim are determined within requirements to meet policy obligations

Completed
Date:

Teacher:

Evidence:

Necessity for urgent action to protect organisation interests is determined

Completed
Date:

Teacher:

Evidence:

Determine settlement options

Settlement options are identified within policy obligations, organisation, legislative and legal requirements

Settlement options are identified within policy obligations, organisation, legislative and legal requirements

Completed
Date:

Teacher:

Evidence:

Manage support arrangements to resolve the claim

Liaise with relevant parties to identify and meet support requirements such as partnering with external experts to ensure clients' needs are met
Manage any legal processes from a non-routine/complex claims perspective, including international legal system requirements, if applicable
Employ mediation skills to resolve issues or disputes associated with a significant claim, as required

Liaise with relevant parties to identify and meet support requirements such as partnering with external experts to ensure clients' needs are met

Completed
Date:

Teacher:

Evidence:

Manage any legal processes from a non-routine/complex claims perspective, including international legal system requirements, if applicable

Completed
Date:

Teacher:

Evidence:

Employ mediation skills to resolve issues or disputes associated with a significant claim, as required

Completed
Date:

Teacher:

Evidence:

Identify any required changes to policy or procedures

Circumstances of claim are documented for consideration in portfolio review
Changes to policy and procedures are instigated to minimise further loss in similar circumstances, if appropriate

Circumstances of claim are documented for consideration in portfolio review

Completed
Date:

Teacher:

Evidence:

Changes to policy and procedures are instigated to minimise further loss in similar circumstances, if appropriate

Completed
Date:

Teacher:

Evidence:

Report findings and update records

Actions, procedures and outcomes are documented and recorded promptly and accurately
Stakeholders are provided with accurate and timely advice regarding claim proceedings
Finalised claims files are stored and maintained according to organisation policy and legislative requirements and codes of practice, as applicable

Actions, procedures and outcomes are documented and recorded promptly and accurately

Completed
Date:

Teacher:

Evidence:

Stakeholders are provided with accurate and timely advice regarding claim proceedings

Completed
Date:

Teacher:

Evidence:

Finalised claims files are stored and maintained according to organisation policy and legislative requirements and codes of practice, as applicable

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 data and apply concepts within organisation business objectives negotiate an acceptable outcome to ensure mutual benefit.
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 setting and reviewing workplace projects and business simulations or scenarios.
Guidance information for assessment

Required Skills and Knowledge

Required skills

highly developed communication skills to:

mediate with clients and others

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

well-developed 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 interpret complex policy documentation, read and interpret documentation from a variety of sources and record and consolidate relevant related information

learning skills to maintain knowledge of changes to compliance legislation and requirements

well-developed evaluation and problem solving skills to identify any issues that have the potential to impact on work outcomes and to develop options to resolve these issues when they arise

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

dispute resolution skills

Required knowledge

industry compliance requirements

organisation business objectives

organisation policy, procedures, guidelines and authorities

regulatory body requirements

relevant common law, legal systems and procedures

roles/responsibilities/jurisdiction of specialists and other authorities

types and categories of insurance policies, industry codes of practice, insurance trends and relevant legislation

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.
Types and categories of policies include:	accidental damage additional benefits burglary/theft business interruption business special risks commercial commercial motor construction risks crop defined events directors and officers domestic electronic equipment employee fraud engineering plant environment and pollution fire and perils general and products liability glass Industrial Special Risks (ISR) livestock machinery breakdown money multi-risk package contracts personal accident and illness professional indemnity public liability sprinkler leakage transit travel.
Specialists may include:	agents investigators medical practitioners solicitors.
Non-routine/complex claims may involve:	claims involving legal procedures, including those that involve working across international boundaries claims involving long-term settlements complex claims involving major losses/bodily injury losses, etc. complex technical determinations high monetary impact important client base.
Relevant parties may include:	broker or agent claimant client consultants government or statutory authorities insured legal or other practitioners manufacturers medical mortgagee principal reinsurer subcontractor suppliers third party trustee.
External experts may include:	accountants architects building consultants engineers legal medical quantity and other surveyors repairers state/local governments valuers other relevant experts as required.
Mediation may be:	simple or complex and involve highly developed interpersonal and analytical skills and the application of mediation and dispute resolution techniques.
Documentation may include:	legal, government, professional and other documents meeting notes minutes official, general and other correspondence reasons for recommending certain actions and settlement options over others records of telephone conversations reference to all data and information considered reports from others such as loss adjusters, assessors, insurers, medical providers and others the basis on which the decision was determined.
Stakeholders may include:	claimants claims managers/specialists insurance broker reinsurers underwriters other relevant parties.

NTISthis.com

Evidence Guide: FNSISV510A - Manage non-routine and complex claims

Student: __________________________________________________

Signature: _________________________________________________

Tips for gathering evidence to demonstrate your skills

FNSISV510A - Manage non-routine and complex claims

Analyse claim to determine validity

Evaluate the impact of a claim

Determine settlement options

Manage support arrangements to resolve the claim

Identify any required changes to policy or procedures

Report findings and update records

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

Instructions to Assessors

Teacher: ___________________________ Date: _