Application
This unit describes the skills and knowledge required to provide an insurance claims service to clients in an insurance broking context.
It applies to individuals who use excellent communication and interpersonal skills within insurance broking organisations of various sizes and across a range of customer bases.
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.
Elements and Performance Criteria
ELEMENT | PERFORMANCE CRITERIA |
Elements describe the essential outcomes. | Performance criteria describe the performance needed to demonstrate achievement of the element. |
1. Register claim | 1.1 Use internal broking claims system to register and process client’s claim in comprehensive and detailed manner 1.2 Update claims recording system regularly and accurately to minimise processing time |
2. Advise insurers and complete necessary documentation | 2.1 Verify appointment of loss adjuster immediately on receiving claim 2.2 Seek formal acknowledgment of receipt of claim immediately from insurers 2.3 Make formal claims reports within brokerage time requirements 2.4 Provide assistance to client to complete claims documentation, when required 2.5 Ensure full and accurate information is available to insurers in assessing claim |
3. Advise client of rights and obligations | 3.1 Formally request insurer to reinstate sum insured where required and inform client where reinstatement occurs 3.2 Review terms and conditions of insurance policy with client to ensure maximum claims recovery is sought 3.3 Advise client on administration of claims to ensure no breach of contract occurs and claims are managed efficiently 3.4 Advise client of appropriate legislative requirements to protect client’s interests |
4. Liaise with service providers | 4.1 Identify need for independent service providers with suitable expertise for claim, where settlement authority exists 4.2 Engage suitable service provider based on client’s instructions where settlement authority exists 4.3 Brief service provider thoroughly to ensure any investigation is comprehensive where settlement authority exists Review and assess service provider’s report within agreed timeframes where settlement authority exists Maintain contact with insurer’s service provider to ensure reports and issues are dealt with promptly |
5. Notify terms of settlement to client and update files and records | 5.1 Prepare details of insurer's settlement offer without delay, with recommendations for client to review 5.2 Obtain and act on client’s response to settlement offer without delay 5.3 Remit settlement funds to client in accordance with legislative requirements and business policy and procedures 5.4 Update business records promptly according to brokerage policy and guidelines |
Evidence of Performance
Evidence of the ability to:
follow organisational procedures to complete a claims register accurately and process client claims
provide the client with accurate and easily understood advice regarding contract terms and conditions and insurance procedures
prepare a report on the settlement offer for client review
research appropriate service providers for provision of claims services.
Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.
Evidence of Knowledge
To complete the unit requirements safely and effectively, the individual must:
explain the application of the brokerage claims systems and procedures
explain the responsibility of the adviser in the claims process
outline the process for analysing insurance contract terms and conditions in relation to the claims process
explain the relevant legislation and code of practice requirements that are to be met by the adviser dealing with client claims.
Assessment Conditions
Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance broking field of work and include access to:
common office equipment, technology, software and consumables
organisational records
organisational policy and procedures.
Assessors must satisfy NVR/AQTF assessor requirements.
Foundation Skills
This section describes language, literacy, numeracy and employment skills incorporated in the performance criteria that are required for competent performance.
Skill | Performance Criteria | Description |
Reading | 2.4, 3.2, 4.4, | Interprets information from a range of sources and identifies relevant and key information |
Writing | 1.2, 2.2, 3.1, 3.3, 3.4, 4.3, 5.1, 5.5 | Accurately records and completes organisational documents and correspondence using clear language and correct spelling, grammar and terminology Writes, edits and proofreads documents to ensure clarity of meaning, and accuracy and consistency of information |
Oral Communication | 3.1, 3.3, 3.4, 4.3 | Articulates clearly using specific and relevant language suitable to the audience to convey requirements Uses listening and questioning techniques to confirm understanding |
Numeracy | 2.3, 4.4, 5.3 | Checks calculations to confirm insurance requirements and settlements Plans and schedules to manage timeframes |
Navigate the world of work | 1.1, 3.3, 3.4, 4.1-4.4, 5.3-5.5 | Recognises and follows relevant legislative requirements, and organisational policy and procedures, and meets expectations of own role |
Interact with others | 2.1, 2.2, 2.4, 2.5, 3.1, 3.2, 4.3, 4.5 | Selects and uses appropriate conventions and protocols when communicating with clients, insurers and service providers in a range of work contexts Recognises and accommodates the particular needs, values, beliefs and cultural expectations of others Implements strategies to establish a sense of connection and build rapport with clients Uses collaborative techniques to negotiate agreed outcomes |
Get the work done | 1.1, 2.1, 2.3, 4.2, 4.4, 4.5, 5.1-5.4 | Plans, sequences and prioritises tasks and own workload to achieve organisational requirements Takes responsibility for planning, organising, implementing and reviewing systems to manage sensitive information Uses digital technologies to access, enter and store information required to complete work tasks |
Sectors
Insurance broking