This unit applies to those processing and settling claims against insurance policies covering life risks.
Not applicable.
1. Review claim settlement advice | 1.1 Receive settlement advice for a claim against a risk-based life insurance policy 1.2 Check that documentation is correct and complete in accordance with procedures 1.3 Confirm that organisational authority levels have been observed |
2. Calculate benefits | 2.1 Identify the extent of liability on the basis of collected evidence and the terms and conditions of the life insurance policy 2.2 Calculate and check benefits payable in accordance with procedures |
3. Finalise claim settlement | 3.1 Advise client of the consequences of proceeding with the 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 |
Required skills
communication skills to:
gather and check information
liaise and share information with others
communicate appropriately with people from diverse backgrounds
numeracy skills to:
interpret numeric data and relevant statistics
calculate life insurance payments
IT skills to:
use computer applications (word processing, spreadsheet, database, specific purpose computer systems)
access and update records electronically
access web-based information services
reading skills to:
read and understand relevant procedures
read and understand life insurance policies
read and interpret life insurance claims and supporting documentation
organisational skills to efficiently plan and sequence work
problem solving skills to address errors in life insurance 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 settlement 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 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 settlement 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 corporate privacy policy 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 |
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.
Risk-based life insurance policy may include: | disability income term life (including terminal illness and Total and Permanent Disablement (TPD)) trauma whole of life. |
Documentation may include: | claim forms records of death records of disablement other medical records statutory declarations and other such records claims assessment outcomes claims department records. |
Procedures may include: | organisational complaints handling processes organisational customer service charter organisational guidelines organisational policy organisational privacy and confidentiality guidelines organisational procedures. |
Evidence may include: | records of death records of disablement other medical records statutory declarations and other such records claims department records. |
Life insurance policy may include | disability income term life (including terminal illness Total and Permanent Disablement (TPD)) trauma whole of life. |
Consequences may include: | terms of settlement discharge of the insurer's contractual obligation for the event claimed changes to terms and conditions of ongoing insurance reduced sum insured for ongoing insurance loss of insurance cover. |
Policy discharge may include: | acceptance by claimant of amount of settlement acceptance by claimant of timing of settlement acceptance by claimant of terms of settlement. |
Appropriate systems may include: | policy administration systems document management systems. |
Appropriate stakeholders may include: | internal parties administrators trustees underwriters claimant and associated parties assignees beneficiaries executors lawyers life insured next of kin policy owners. |
Regulatory requirements may include: | life insurance legislation corporations legislation privacy legislation Australian Securities and Investments Commission (ASIC) regulatory guides industry Codes of Practice. |
Life insurance
This unit contains employability skills.
No licensing, legislative, regulatory or certification requirements apply to this unit at the time of publication.