Application
This unit applies to job roles involving specialist knowledge and functions including claims and underwriting in a range of insurance sectors and may be applied within organisations of various sizes and across a range of customer bases. |
Elements and Performance Criteria
ELEMENT | PERFORMANCE CRITERIA |
1. Clarify the brief and the instructions | 1.1. The brief provided to the investigator is clarified including the facts of the claim, the insurer's instructions and outcomes required 1.2. The subject matter questions to be investigated are checked |
2. Investigate claim | 2.1. Method of investigation is determined 2.2. Required information is collected and organised to make a logical case 2.3. Investigations are carried out in accordance with legislation, regulations and organisation operating procedures and codes of practice, if applicable 2.4. All data and information is recorded progressively and accurately 2.5. All original documents, tapes, photographs and other material are filed and stored securely 2.6. Appropriate changes in the brief or instructions are prepared and communicated 2.7. Any changes in the brief or the instructions are complied with |
3. Report on the investigation | 3.1. Comprehensive reports are prepared and transmitted according to reporting guidelines 3.2. Copies of the documents, tapes, photographs and other materials are provided to the insurer's nominated person 3.3. Facts and justification for conclusions are given to the insurer's nominated person 3.4. Recommendations for action are made, with appropriate justifications, where required |
Required Skills
|
Required skills |
highly developed communication skills to: determine and confirm information, using questioning and active listening as required relate effectively to customers liaise with others, share information, listen and understand use language and concepts appropriate to cultural differences well-developed numeracy and IT skills to: perform calculations related to achieving required outcomes use investigative tools such as cameras, recorders use computer applications (word processing, spreadsheet, database, specific purpose computer systems) to assist in achieving required outcomes access and update records electronically access web based information services well developed literacy skills to read and interpret documentation from a variety of sources and record and consolidate relevant related information learning skills to maintain knowledge of changes to compliance legislation and requirements problem solving skills to identify any issues that have the potential to impact on work outcomes and to develop options to resolve these issues when they arise self-management skills for complying with ethical, legal and procedural requirements research and analysis skills for accessing and interpreting relevant information organisational skills, including the ability to plan and sequence work |
Required knowledge |
appropriate investigation methods including: interviews surveillance internet research how to establish the authenticity of document observation industry codes of practice organisation policy and procedures relevant legislation and regulations particularly the Privacy Act report writing conventions |
Evidence Required
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: interpret and comply with relevant legislation and regulatory requirements implement investigation methodologies apply comprehensive understanding of the industry sector and all legal obligations and organisation procedures in relation to investigating claims produce complete and accurate investigation reports. |
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 organisation records access to organisation policies and procedures. |
Method of assessment | A range of assessment methods should be used to assess practical skills and knowledge. The following examples, in combination, 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 |
Range Statement
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. | |
The brief may include: | claims history information provided by the customer witness statements. |
Subject matter may include: | corporations evidence incidents individuals locations objects processes statements. |
Methods of investigation may include: | interviews mechanical or chemical analysis observation phone calls review of documents other relevant information gathering activities. |
Investigations may include: | corroboration or analysis of subject matter determining causes or sequence of events extent of liability identification of subject matter suspected or potential fraud validation of evidence other actual or potential problems. |
Data and information collected may include: | audio and video tapes documents electronic records photographs subject matter and other relevant materials. |
Comprehensive reports may include: | findings photos recommendations witness statements. |
Reporting guidelines may include: | areas to be excluded attachments and evidence frequency and number of reports level of detail limits and types of enclosures methods of transmission structure of reports and number copies topics to be covered. |
The nominated person may include: | the person monitoring the investigation on behalf of the organisation. |
Sectors
Unit sector | Insurance services |
Employability Skills
This unit contains employability skills. |
Licensing Information
Not applicable.