Application
This unit describes the skills and knowledge required to review claims history, predict future claims costs and review policies and procedures, including analysing data, preparing reports on claims and monitoring trends in claims settlement to advise on changes to minimise losses.
It applies to individuals working in claims and underwriting job roles 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. Collect and analyse data on claims trends | 1.1 Design and implement data gathering processes 1.2 Identify new data requirements and sources, and establish process for collecting data 1.3 Analyse data collected to identify trends in claims and related documents |
2. Monitor claims trends | 2.1 Prepare accurate and timely claims reports to document trends and identify issues, where appropriate 2.2 Communicate to management promptly relevant information which impacts on clients according to organisational procedures |
3. Identify opportunities to improve client outcomes | 3.1 Assist clients to identify changes to policies and procedures that will improve health and safety and return to work practices, and minimise claims costs in similar circumstances 3.2 Communicate advice to clients effectively and promote positive action 3.3 Provide sources of advice to clients where required |
Evidence of Performance
Evidence of the ability to:
collect and interpret data from a wide range of sources
effectively monitor and analyse:
claims trends and their causes
effects on claims history
settlement policy and procedures
review policies and procedures and make recommendations for change
accurately prepare advice and recommendations for management and clients to undertake suitable actions.
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 organisational policy, procedures, claims guidelines and levels of authority
explain and employ analysis techniques in evaluating data
outline broad industry trends in claims handling
explain the different type of claims events and possible remediation strategies
outline the types of data and documents to be analysed to monitor claim trends.
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 | 1.2, 1.3 | Analyses documentation from a variety of sources and records and consolidates information to determine requirements |
Writing | 1.1, 1.2, 2.1, 2.2, 3.1, 3.2, 3.3 | Writes, edits and proofreads documents to ensure clarity of meaning, and accuracy and consistency of information Documents outcomes and changes to policies and procedures using industry relevant terminology Accurately records information and prepares correspondence and documentation using clear language and organisational formats and protocols |
Oral Communication | 2.2, 3.1, 3.2, 3.3 | Conveys and clarifies information effectively to a range of personnel using active listening and questioning to confirm understanding |
Numeracy | 1.3, 3.1 | Performs mathematical calculations to analyse financial information, costs and values |
Navigate the world of work | 2.2 | Takes full responsibility for following policies, procedures and legislative requirements and identifies organisational implications of new legislation or regulation |
Interact with others | 2.2, 3.1, 3.2 | 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 diverse clients |
Get the work done | 1.1-1.3, 3.1, 3.3 | Accepts responsibility for planning and sequencing complex tasks and workload, negotiating key aspects with others and taking into account capabilities, efficiencies and effectiveness Investigates new and innovative ideas as a means to continuously improve work practices and processes through consultation, and formal and analytical thinking |
Sectors
Insurance services