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

FNSISV509 Mapping and Delivery Guide
Analyse financial, medical and psychological claims assessments

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency FNSISV509 - Analyse financial, medical and psychological claims assessments
Description
Employability Skills
Learning Outcomes and Application This unit describes the skills and knowledge required to arrange financial, medical or psychological assessments to support the claims assessment process and to analyse and report on the results.It applies to individuals working in job roles involving specialist knowledge and functions in a range of insurance sectors and may be applied to areas of claims assessment involving personal injury, long-term settlement and/or complex claims.Work functions in the occupational areas where this unit may be used are subject to regulatory requirements. Refer to the FNS Implementation Guide Companion Volume or the relevant regulator for specific guidance on requirements.
Duration and Setting X weeks, nominally xx hours, delivered in a classroom/online/blended learning setting.

Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance services field of work and include access to:

organisational records

organisational policy, procedures, legislation and regulations as they relate to contracts of insurance

a range of common technology and software.

Assessors must satisfy NVR/AQTF assessor requirements.
Prerequisites/co-requisites
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: Establish need to appoint specialist to undertake assessment
  • Review thoroughly, systematically and accurately, the facts, evidence and information, including fraud indicators, relevant to circumstances of loss, damage and injury
  • Identify promptly and advise client and other relevant parties of need to appoint specialist assistance to undertake financial, medical or psychological assessment
       
Element: Organise financial, medical or psychological assessments
  • Engage appointed specialists, as required, and thoroughly brief them on requirements
  • Monitor assessment activity progress and report to relevant parties, as appropriate, within set timelines
       
Element: Analyse data for claims assessments
  • Analyse and assess financial, medical or psychological assessment data for thoroughness and consistency
  • Use analysis tools to assess financial, medical and/or psychological assessments to calculate loss damages
  • Assess fairly and impartially validity of loss situation and/or claims against assessment data, and analyse against reported circumstances, available evidence, facts and information
  • Review insurance cover and policy conditions to ensure loss falls within policy coverage
       
Element: Report results
  • Document and report assessment actions, procedures and outcomes, and record promptly and accurately
  • Ensure reporting includes recommendations on validity of claim and recovery amounts in relation to assessment and other relevant data
  • Provide stakeholders with accurate and timely advice regarding financial, medical or psychological assessment for claim proceedings
       


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.

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Establish need to appoint specialist to undertake assessment

1.1 Review thoroughly, systematically and accurately, the facts, evidence and information, including fraud indicators, relevant to circumstances of loss, damage and injury

1.2 Identify promptly and advise client and other relevant parties of need to appoint specialist assistance to undertake financial, medical or psychological assessment

2. Organise financial, medical or psychological assessments

2.1 Engage appointed specialists, as required, and thoroughly brief them on requirements

2.2 Monitor assessment activity progress and report to relevant parties, as appropriate, within set timelines

3. Analyse data for claims assessments

3.1 Analyse and assess financial, medical or psychological assessment data for thoroughness and consistency

3.2 Use analysis tools to assess financial, medical and/or psychological assessments to calculate loss damages

3.3 Assess fairly and impartially validity of loss situation and/or claims against assessment data, and analyse against reported circumstances, available evidence, facts and information

3.4 Review insurance cover and policy conditions to ensure loss falls within policy coverage

4. Report results

4.1 Document and report assessment actions, procedures and outcomes, and record promptly and accurately

4.2 Ensure reporting includes recommendations on validity of claim and recovery amounts in relation to assessment and other relevant data

4.3 Provide stakeholders with accurate and timely advice regarding financial, medical or psychological assessment for claim proceedings

Evidence of the ability to:

interpret and identify circumstances in which specialist assistance should be sought for the resolution of a claim

correctly analyse claims information to determine the need for specialist assistance

engage specialist assistance as appropriate

monitor the specialist assessment activity

interpret and report on the outcomes of the advice in relation to the claim.

Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.

To complete the unit requirements safely and effectively, the individual must:

describe methods, practices and guidelines for performing data analysis

describe ‘claims management’ as it applies to specialist circumstances

identify policy coverage and requirements

outline the principles of cost estimating in claims assessments

identify and explain key features of relevant legislation, regulatory guidelines and industry sector codes of practice

explain the roles and responsibilities of financial, medical and psychological specialists

describe the types and/or categories of insurance policies associated with financial, medical and psychological claims

describe analysis tools used to assess financial, medical and/or psychological assessments to calculate loss damages.

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.

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Establish need to appoint specialist to undertake assessment

1.1 Review thoroughly, systematically and accurately, the facts, evidence and information, including fraud indicators, relevant to circumstances of loss, damage and injury

1.2 Identify promptly and advise client and other relevant parties of need to appoint specialist assistance to undertake financial, medical or psychological assessment

2. Organise financial, medical or psychological assessments

2.1 Engage appointed specialists, as required, and thoroughly brief them on requirements

2.2 Monitor assessment activity progress and report to relevant parties, as appropriate, within set timelines

3. Analyse data for claims assessments

3.1 Analyse and assess financial, medical or psychological assessment data for thoroughness and consistency

3.2 Use analysis tools to assess financial, medical and/or psychological assessments to calculate loss damages

3.3 Assess fairly and impartially validity of loss situation and/or claims against assessment data, and analyse against reported circumstances, available evidence, facts and information

3.4 Review insurance cover and policy conditions to ensure loss falls within policy coverage

4. Report results

4.1 Document and report assessment actions, procedures and outcomes, and record promptly and accurately

4.2 Ensure reporting includes recommendations on validity of claim and recovery amounts in relation to assessment and other relevant data

4.3 Provide stakeholders with accurate and timely advice regarding financial, medical or psychological assessment for claim proceedings

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
Review thoroughly, systematically and accurately, the facts, evidence and information, including fraud indicators, relevant to circumstances of loss, damage and injury 
Identify promptly and advise client and other relevant parties of need to appoint specialist assistance to undertake financial, medical or psychological assessment 
Engage appointed specialists, as required, and thoroughly brief them on requirements 
Monitor assessment activity progress and report to relevant parties, as appropriate, within set timelines 
Analyse and assess financial, medical or psychological assessment data for thoroughness and consistency 
Use analysis tools to assess financial, medical and/or psychological assessments to calculate loss damages 
Assess fairly and impartially validity of loss situation and/or claims against assessment data, and analyse against reported circumstances, available evidence, facts and information 
Review insurance cover and policy conditions to ensure loss falls within policy coverage 
Document and report assessment actions, procedures and outcomes, and record promptly and accurately 
Ensure reporting includes recommendations on validity of claim and recovery amounts in relation to assessment and other relevant data 
Provide stakeholders with accurate and timely advice regarding financial, medical or psychological assessment for claim proceedings 

Forms

Assessment Cover Sheet

FNSISV509 - Analyse financial, medical and psychological claims assessments
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

FNSISV509 - Analyse financial, medical and psychological claims assessments

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: