Application
This unit describes the skills and knowledge required to collect, collate and manage information to verify, investigate and assess insurance claims.
It applies to individuals who use specialised knowledge and organisational skills to effectively manage information.
No licensing, legislative or certification requirements apply to this unit at the time of publication.
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. Identify information needs | 1.1 Review claim files and life insurance policy to identify payment criteria 1.2 Identify additional information needed as evidence for claims assessment |
2. Plan information collection | 2.1 Identify appropriate sources of required proofs 2.2 Select and enact an appropriate information collection method |
3. Collect and manage information | 3.1 Collect additional information from appropriate sources in accordance with procedures 3.2 Manage investigations in accordance with ethical and regulatory requirements 3.3 Consult appropriate personnel within organisation where investigations reveal need to escalate issues for clarification 3.4 Organise information for clarity and accessibility in accordance with procedures |
Evidence of Performance
Evidence of the ability to:
gather information in a format suitable to facilitate assessment of claims
perform claims assessment tasks in accordance with relevant procedures and regulatory requirements.
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:
outline life insurance administrative requirements relating to life insurance claims assessment
explain life insurance policy payment criteria
outline life insurance policy terms and conditions
outline organisational procedures relating to life insurance claims assessment
explain organisational systems for data entry and filing
explain product information
outline relevant regulatory requirements relating to life insurance claims assessment
outline potential areas in the claims process that may require detailed investigation.
Assessment Conditions
Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the life insurance field of work and include access to:
office equipment, technology, software and consumables
organisational records, 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 | 1.1, 1.2, 2.1, 3.1, 3.4 | Gathers, analyses and interprets simple to complex information from a range of sources and identifies relevant information |
Writing | 2.1, 3.1, 3.4 | Produces texts of varying complexity using appropriate technical and industry language, grammar and logical sequence to convey and record information accurately and effectively |
Oral Communication | 3.1, 3.3 | Uses active listening and questioning techniques to extract relevant information and confirm understanding |
Numeracy | 1.1 | Interprets numerical information and performs basic calculations in accordance with organisational guidelines |
Navigate the world of work | 3.1-3.4 | Recognises and follows legislative and ethical requirements, explicit and implicit protocols, policies and procedures |
Interact with others | 2.2, 3.2, 3.3 | Selects and uses appropriate communication conventions and protocols to liaise with others Adjusts personal communication style in response to the values, beliefs and cultural expectations of others |
Get the work done | 1.1, 1.2, 2.1, 2.2, 3.1-3.4 | Takes responsibility for planning, sequencing and prioritising tasks and own workload for efficiency and effectiveness Systematically gathers and analyses all relevant information and evaluates options to inform decisions about collection methods Uses the main features and functions of digital tools to complete work tasks |
Sectors
Life insurance