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Elements and Performance Criteria

Review claim settlement advice
Calculate benefits
- Identify the extent of liability on the basis of collected evidence and the terms and conditions of the life insurance policy
- Calculate and check benefits payable in accordance with procedures
Finalise claim settlement

Required Skills

Required skills

communication skills to

gather and check information

liaise and share information with others

communicate appropriately with people from diverse backgrounds

numeracy skills to

interpret numeric data and relevant statistics

calculate life insurance payments

use computer applications word processing spreadsheet database specific purpose computer systems

access and update records electronically

access webbased information services

reading skills to

read and understand relevant procedures

read and understand life insurance policies

read and interpret life insurance claims and supporting documentation

organisational skills to efficiently plan and sequence work

problem solving skills to address errors in life insurance documentation

research and analysis skills to

identify and interpret relevant information

analyse information and data

maintain currency of products and services knowledge

writing skills to

accurately record information

prepare professional letters and emails

Required knowledge

the ability to apply and explain as relevant to the settlement of life insurance claims

life insurance administrative requirements

life insurance policy payment criteria

life insurance policy terms and conditions

organisational procedures

organisational systems for data entry and filing

product information

relevant regulatory requirements

Evidence Required

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

apply analytical and administrative skills in the settlement of claims

maintain and apply a thorough and uptodate understanding of life insurance terms and conditions and claims processing

maintain and apply a thorough and uptodate understanding of life insurance administrative requirements

perform tasks in accordance with relevant procedures and regulatory requirements

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 records

access to corporate privacy policy

access to organisational policies and procedures

Method of assessment

A range of assessment methods should be used to assess practical skills and knowledge The following examples 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

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.

Risk-based life insurance policy may include:	disability income term life (including terminal illness and Total and Permanent Disablement (TPD)) trauma whole of life.
Documentation may include:	claim forms records of death records of disablement other medical records statutory declarations and other such records claims assessment outcomes claims department records.
Procedures may include:	organisational complaints handling processes organisational customer service charter organisational guidelines organisational policy organisational privacy and confidentiality guidelines organisational procedures.
Evidence may include:	records of death records of disablement other medical records statutory declarations and other such records claims department records.
Life insurance policy may include	disability income term life (including terminal illness Total and Permanent Disablement (TPD)) trauma whole of life.
Consequences may include:	terms of settlement discharge of the insurer's contractual obligation for the event claimed changes to terms and conditions of ongoing insurance reduced sum insured for ongoing insurance loss of insurance cover.
Policy discharge may include:	acceptance by claimant of amount of settlement acceptance by claimant of timing of settlement acceptance by claimant of terms of settlement.
Appropriate systems may include:	policy administration systems document management systems.
Appropriate stakeholders may include:	internal parties administrators trustees underwriters claimant and associated parties assignees beneficiaries executors lawyers life insured next of kin policy owners.
Regulatory requirements may include:	life insurance legislation corporations legislation privacy legislation Australian Securities and Investments Commission (ASIC) regulatory guides industry Codes of Practice.