Application
This unit describes the skills and knowledge required to calculate benefits and settle claims made under risk based life insurance policies.
It applies to individuals who use specialised knowledge and systematic approaches to process and settle life insurance claims.
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. Review claim settlement advice | 1.1 Receive settlement advice for claim against risk based life insurance policy 1.2 Check that documentation is correct and complete in accordance with procedures 1.3 Resolve any discrepancies identified between claim and settlement advice 1.4 Confirm that organisational authority levels have been observed |
2. Calculate benefits | 2.1 Identify extent of liability on basis of collected evidence, and terms and conditions of life insurance policy 2.2 Calculate and check benefits payable in accordance with procedures |
3. Finalise claim settlement | 3.1 Advise client of consequences of proceeding with payment in accordance with procedures 3.2 Obtain policy discharge as appropriate 3.3 Confirm method of payment with claimant 3.4 Enter and confirm payment information on appropriate systems to make payment 3.5 Communicate settlement details to appropriate stakeholders in accordance with procedures and regulatory requirements 3.6 Update records and file documentation in accordance with procedures and regulatory requirements |
Evidence of Performance
Evidence of the ability to:
perform claims settlement tasks in accordance with relevant procedures and regulatory requirements including:
checking claims settlement advice against claims to identify and resolve variations
calculating benefits
communicating settlement details
updating documentation.
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 settlement
explain life insurance policy payment criteria
outline key features of life insurance policy terms and conditions, and claims settlement
outline organisational procedures relating to life insurance claims processing and settlement
explain organisational systems for data entry and filing
outline the various types of life insurance policies
outline relevant regulatory requirements relating to life insurance claims settlement
outline the various stakeholders in the life insurance claims process.
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, 1.4, 2.1 | Gathers, analyses and interprets simple to complex information from a range of sources, and identifies relevant information |
Writing | 3.1-3.6 | 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 | 1.3, 3.1-3.3, 3.5 | Uses active listening and questioning techniques to validate information Uses clear, specific and technically correct language to convey information |
Numeracy | 2.1, 2.2 | Interprets numerical information and performs calculations in accordance with organisational guidelines |
Navigate the world of work | 1.2, 1.3, 1.4, 2.2, 3.1, 3.5, 3.6 | Recognises and follows legislative requirements, explicit and implicit protocols, policies and procedures and meets expectations associated with own role |
Interact with others | 1.3, 3.1, 3.2, 3.3, 3.5 | 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 | 1.2, 1.3, 1.4, 2.1, 2.2, 3.1, 3.4-3.6 | 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 benefits Uses the main features and functions of digital tools to complete work tasks |
Sectors
Life insurance