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Elements and Performance Criteria

  1. Interpret documents and instructions which contain specialist insurance terminology
  2. Use appropriate specialist terminology in written and oral communication related to a claim
  3. Apply specialist terminology to claims tasks
  4. Extend understanding of specialist terminology

Required Skills

Required skills

welldeveloped communication skills to

accurately pronounce specialist terminology

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 webbased information services

welldeveloped literacy skills to

read and interpret documentation from a variety of sources and record and consolidate relevant related information

read and interpret legalmedicalinsurance documents related to a claim

understand and use vocabulary for a specific purpose

clarify intended meaning and context

follow written and oral sequenced instructions involving specialist terminology in insurance

selfmanagement 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

IT and communications systems

organisation policy procedures underwritingclaims guidelines and authorities

policy coveragerequirements

procedures in relation to communication and the release of information security and confidentiality

relevant legislation and industry codes of practice

typescategories of insurance policies

legal terminology

insurance law

commonly used legal terminology in insurance

appropriate use of legal terminology within employees area of responsibility within an insurance context

relevant legal process as it relates to insurance andor legal claims proceedings

medical terminology

medical terminology used in insurance and sources of information

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

interpret instructions containing commonly used specialist terminology and abbreviations are responded to appropriately

maintain knowledge of specialist terminology used in insurance

use specialist terminology in insurance appropriately for the situation

access an appropriate personsource of information to clarify unclear instructions or to locate missing information

explain specialist terminology and processes applied to insurance to others in simple nonspecialist language with nondisclosable information is not communicated

understand legal and financial consequences of misusing legal terminology

conduct all work within accepted organisation and ethical codes of conduct including those relating to maintaining confidentiality privacy and compliance

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


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.

Written and oral instructions may include:

notices

telephone calls

terms and conditions of claim

verbal instructions

written advice.

Commonly used/appropriate specialist terminology in insurance may relate to:

legislation and regulations

insurance policy and claims documentation

risk management policies and practices

legal terminology:

courts and tribunals

legal personnel

legal systems, processes and procedures

legal documentation

abbreviations for legal terms

legal terminology in insurance may vary according to:

the area of law

legal system/country to which claim relates

a particular legal procedure

the jurisdiction

the type of policy or coverage

medical terminology:

knowledge of medical specialties and the names and titles of doctors working in specialist fields

illnesses

injuries

diseases

interrelated functions of the body, locations and diseases (e.g. functions of the skeletal system, locations of skeletal injuries, skeletal diseases)

terms to describe onset and/or nature of disease

medical conditions

medical investigations and procedures

abbreviations for medical and pharmacological terms

medical equipment and instruments

departments/sections in a hospital

medications

health insurance or WorkCover terminology

Medicare terminology

referrals.

Claims documentation may include:

case reports

correspondence to a range of medical/hospital/legal professionals on claimant related matters

database information

files

forms

insurance policy documents and coverage details

letters

minutes

telephone messages

medical documentation:

claimant medical history

claimant medical records

routine medical reports associated with the claim

claimant test results.

Assistance or clarification may be sought from:

organisation policy, procedures and guidelines

insurance information/databases

claims manager/specialist or designated supervisor

underwriter or underwriting specialist/manager

other designated person/s

medical terminology clarification/assistance:

medical dictionary

medical information sources/databases

legal terminology clarification/assistance:

legal dictionary

glossary of commonly use legal terminology and processes used in insurance claims

legal team representatives.

Specialist representatives or designated person may include:

claims manager/specialist or designated supervisor

legal team representative

underwriter or underwriting specialist/manager

WorkCover or specialist medical representative.

Tasks may include:

contacting relevant internal or external parties

dealing with enquiries

drafting letters in response to claims case queries

maintenance/update of claims files and databases (e.g. file notes, correspondence, reports)

producing memos, reports

medical terminology related claims tasks:

research/arranging medical or psychological assessments for claim

legal terminology related claims tasks:

research for claim and related legal proceedings

preparing documentation to support legal proceedings

providing verbal and/or written advice and information on the status of legal proceedings for a claim.

Compliance may include:

all activities covered in this unit to be undertaken in line with the relevant current:

legislation

regulations

organisation operating procedures

codes of practice, where applicable.

Relevant legislation may include:

building or construction

Consumer Credit Code

contract law

environmental

hazardous materials

industry codes of practice

Insurance Agents and Brokers Act

Insurance Contracts Act

motor vehicle

occupational health and safety (OHS)

Privacy Act

Statutes of limitations

secrecy laws

Trade Practices Act.