FNSISV507
Implement claim recovery procedures


Application

This unit describes the skills and knowledge required to recover money relating to a claim. It encompasses the complete process, from initiating the recovery to finalisation of the claim.

It applies to individuals working in job roles such as underwriting, involving specialist knowledge and functions in a range of insurance sectors, and may be applied within organisations of various sizes and across a range of client 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. Establish viability of recovery

1.1 Identify sources and rights of recovery

1.2 Make accurate calculation of achievable recovery amounts

1.3 Evaluate extent of recovery success

2. Evaluate recovery methods

2.1 Determine benefit to organisation of using each of available recovery methods, following organisational operating procedures

2.2 Assess methods for compliance with relevant legislative and organisational policy requirements

2.3 Ensure recovery action selected is appropriate to circumstances of loss

2.4 Instigate recovery of correct amount from reinsurers, where appropriate

2.5 Appoint agents to undertake loss recovery, where necessary

3. Implement and monitor recovery progress

3.1 Issue demand to responsible party

3.2 Confirm knock for knock, if applicable

3.3 Utilise diary system to monitor follow up

3.4 Make referral to solicitor or other relevant service provider, if applicable

3.5 Implement and follow up recovery within specified timeframes and organisational guidelines

4. Negotiate recovery settlement

4.1 Negotiate recovery settlement on best terms according to organisational policy

4.2 Complete negotiation within timeframes and organisational procedures

5. Process monies

5.1 Check file to determine whether recovery money has been received

5.2 Prepare payment information and enter on system to facilitate payment of claim by finance department, where applicable

5.3 Pay promptly client’s share of recovery money, where applicable

5.4 Finalise claims according to legislation, regulations, organisational operating procedures and codes of practice, if applicable

6. Record outcome

6.1 Update promptly all relevant records and files to display recovery action, amounts and other pertinent detail

6.2 Advise underwriter of any special circumstances, if applicable

Evidence of Performance

Evidence of the ability to:

collate information and determine the viability of a recovery

review options and determine a suitable claim recovery method

initiate recovery and monitor the progress

engage in negotiations to secure settlement conditions

calculate achievable recovery amounts

oversee the financial transactions of payments

maintain accurate records

make referrals to solicitors or other service providers for recoveries.

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:

identify and apply relevant legislation, regulatory guidelines and industry sector compliance requirements as they apply to:

insurance contracts

consumer protection

privacy

taxation laws

credit laws

describe the importance of the legal aspects of insurance agents and brokers

identify and describe legal precedents and previous organisational results for claims recovery

explain the importance of wording of insurance policies in keeping with the organisation or industry sector

outline organisational policy, procedures, insurance guidelines and levels of authority in claim recovery processes

explain relative industry sector hazards associated with claims recovery.


Assessment Conditions

Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance services field of work and include access to:

organisational records

organisational policy, procedures, legislation and regulations as they relate to contracts of insurance

a range of common technology and software.

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, 1.3, 2.1, 2.2, 3.2, 5.1

Interprets, consolidates and checks completeness and accuracy of information and data

Writing

2.4, 2.5, 3.1, 3.2, 3.3, 3.4, 3.5, 4.1, 4.2, 5.2, 5.3, 6.1, 6.2

Accurately records communications and data, and completes organisational documents and correspondence using clear language and correct spelling, grammar and terminology

Oral Communication

2.5, 3.1, 3.2, 3.4, 4.1, 4.2, 6.2

Participates in verbal exchanges, using active listening and questioning, to convey and clarify information and to confirm understanding

Numeracy

1.2, 2.4, 5.1, 5.2, 5.3

Performs mathematical calculations to analyse financial information, costs and values, and accurately process claims

Navigate the world of work

2.2, 3.5, 4.1, 4.2, 5.4

Takes full responsibility for following policies, procedures and legislative requirements

Identifies and resolves key business issues, processes and practices that may have legal implications

Interact with others

2.4, 2.5, 4.1, 6.2

Selects and uses appropriate conventions and protocols when communicating with clients and co-workers in a range of work contexts

Implements strategies to build rapport and foster strong relationships with colleagues and clients

Get the work done

1.1, 1.3, 2.1-2.4, 3.1-3.5, 4.2, 5.1-5.4, 6.1

Plans and sequences complex tasks and workload, negotiating key aspects with others and taking into account capabilities, efficiencies and effectiveness

Makes critical decisions quickly and intuitively in complex situations, taking into consideration a range of variables including the outcomes of previous decisions

Uses digital technologies to access, enter and store information required to complete work tasks


Sectors

Insurance services