Unit of Competency Mapping – Information for Teachers/Assessors – Information for Learners

FNSILF405A Mapping and Delivery Guide
Evaluate life insurance claims

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency FNSILF405A - Evaluate life insurance claims
Description This unit describes the performance outcomes, skills and knowledge required to handle the receipt, initial assessment and processing of claims made under risk-based life insurance policies.
Employability Skills This unit contains employability skills.
Learning Outcomes and Application This unit applies to those engaged in claims management functions of Life Insurance organisations.
Duration and Setting X weeks, nominally xx hours, delivered in a classroom/online/blended learning setting.
Prerequisites/co-requisites Not applicable.
Competency Field
Development and validation strategy and guide for assessors and learners Student Learning Resources Handouts
Activities 		Slides
PPT 		Assessment 1 Assessment 2 Assessment 3 Assessment 4
Elements of Competency Performance Criteria              
Element: Receive claim form
  • Receive claim form and compile necessary documentation
  • Review policy details to ensure valid cover is in force
  • Establish that the claimant is authorised to deal with the policy
  • Check that documentation is correct and complete
  • Determine authority level required to evaluate the claim and refer application to appropriate authority as necessary
       
Element: Evaluate claim information
  • Identify and review evidence against payment criteria
  • Check whether the terms and conditions of the policy have been verifiably met
  • Identify whether policy exclusions apply
  • Seek additional specialist advice as appropriate
  • Recognise where information suggests unresolved complexity and seek further information as appropriate
       
Element: Establish liability for payment
  • Determine whether claim can be admitted in accordance with procedures and within authority limits
  • Make payment recommendation in accordance with procedures
  • Communicate outcomes to all relevant parties in accordance with procedures
  • Update records and file documentation in accordance with procedures and regulatory requirements
       


Evidence Required

List the assessment methods to be used and the context and resources required for assessment. Copy and paste the relevant sections from the evidence guide below and then re-write these in plain English.

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 evaluation of claims

maintain and apply a thorough and up-to-date understanding of life insurance terms and conditions and claims processing

maintain and apply a thorough and up-to-date 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 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

Submission Requirements

List each assessment task's title, type (eg project, observation/demonstration, essay, assignment, checklist) and due date here

Assessment task 1: [title]      Due date:

(add new lines for each of the assessment tasks)

Assessment Tasks

Copy and paste from the following data to produce each assessment task. Write these in plain English and spell out how, when and where the task is to be carried out, under what conditions, and what resources are needed. Include guidelines about how well the candidate has to perform a task for it to be judged satisfactory.

Required skills

communication skills to:

to gather and check information

liaise and share information with others

communicate appropriately with people from diverse backgrounds

IT skills to:

use computer applications (word processing, spreadsheet, database, specific purpose computer systems)

access and update records electronically

numeracy skills to:

calculate life insurance payments

organisational skills to efficiently plan and sequence work

problem solving skills to address errors in life insurance documentation

reading skills to:

read and understand relevant procedures

read and understand life insurance policies

read and interpret life insurance claims and supporting 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 initial evaluation 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.

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.

Documentation may include:

financial records

other medical records

records of birth

records of death

records of disablement

statutory declarations and other such records.

Valid cover may include:

policy is current

premiums are up to date.

Appropriate authority may include:

supervisor

manager

other levels of management.

Payment criteria may include evidence of:

death (including terminal illness)

invalidity (permanent or temporary disability)

trauma.

Policy exclusions may include:

geographical location

high risk activities

medical conditions

pre-existing illnesses.

Specialist advice may include:

accountants

administrators

investigation agencies

Chief Medical Officers

trustees

underwriters

government regulators

Australian Securities and Investments Commission (ASIC)

Australian Tax Office (ATO).

Unresolved complexity may include indicators of possible:

fraud

misrepresentation

non-disclosure.

Further information may include:

additional questionnaires

employment details

financial evidence

interviews

medical evidence

surveillance.

Procedures may include:

organisational complaints handling processes

organisational customer service charter

organisational guidelines

organisational policy

organisational privacy and confidentiality guidelines

organisational procedures.

Outcomes may include:

admit claim

amend claim

investigate claim

deny claim.

Relevant parties may include:

claimant

adviser

other relevant business teams.

Regulatory requirements may include:

Australian Securities and Investments Commission (ASIC) regulatory guides

corporations legislation

insurance contracts legislation

life insurance legislation

privacy legislation.

Copy and paste from the following performance criteria to create an observation checklist for each task. When you have finished writing your assessment tool every one of these must have been addressed, preferably several times in a variety of contexts. To ensure this occurs download the assessment matrix for the unit; enter each assessment task as a column header and place check marks against each performance criteria that task addresses.

Observation Checklist

Tasks to be observed according to workplace/college/TAFE policy and procedures, relevant legislation and Codes of Practice Yes No Comments/feedback
Receive claim form and compile necessary documentation 
Review policy details to ensure valid cover is in force 
Establish that the claimant is authorised to deal with the policy 
Check that documentation is correct and complete 
Determine authority level required to evaluate the claim and refer application to appropriate authority as necessary 
Identify and review evidence against payment criteria 
Check whether the terms and conditions of the policy have been verifiably met 
Identify whether policy exclusions apply 
Seek additional specialist advice as appropriate 
Recognise where information suggests unresolved complexity and seek further information as appropriate 
Determine whether claim can be admitted in accordance with procedures and within authority limits 
Make payment recommendation in accordance with procedures 
Communicate outcomes to all relevant parties in accordance with procedures 
Update records and file documentation in accordance with procedures and regulatory requirements 

Forms

Assessment Cover Sheet

FNSILF405A - Evaluate life insurance claims
Assessment task 1: [title]

Student name:

Student ID:

I declare that the assessment tasks submitted for this unit are my own work.

Student signature:

Result: Competent Not yet competent

Feedback to student

 

 

 

 

 

 

 

 

Assessor name:

Signature:

Date:

Assessment Record Sheet

FNSILF405A - Evaluate life insurance claims

Student name:

Student ID:

Assessment task 1: [title] Result: Competent Not yet competent

(add lines for each task)

Feedback to student:

 

 

 

 

 

 

 

 

Overall assessment result: Competent Not yet competent

Assessor name:

Signature:

Date:

Student signature:

Date: