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Elements and Performance Criteria

  1. Analyse claim to determine validity
  2. Evaluate the impact of a claim
  3. Determine settlement options
  4. Manage support arrangements to resolve the claim
  5. Identify any required changes to policy or procedures
  6. Report findings and update records

Required Skills

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

welldeveloped 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 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

welldeveloped 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

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

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

rolesresponsibilitiesjurisdiction of specialists and other authorities

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

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 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


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.