Application
This unit describes the skills and knowledge required to arrange financial, medical or psychological assessments to support the claims assessment process and to analyse and report on the results.
It applies to individuals working in job roles involving specialist knowledge and functions in a range of insurance sectors and may be applied to areas of claims assessment involving personal injury, long-term settlement and/or complex claims.
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 need to appoint specialist to undertake assessment | 1.1 Review thoroughly, systematically and accurately, the facts, evidence and information, including fraud indicators, relevant to circumstances of loss, damage and injury 1.2 Identify promptly and advise client and other relevant parties of need to appoint specialist assistance to undertake financial, medical or psychological assessment |
2. Organise financial, medical or psychological assessments | 2.1 Engage appointed specialists, as required, and thoroughly brief them on requirements 2.2 Monitor assessment activity progress and report to relevant parties, as appropriate, within set timelines |
3. Analyse data for claims assessments | 3.1 Analyse and assess financial, medical or psychological assessment data for thoroughness and consistency 3.2 Use analysis tools to assess financial, medical and/or psychological assessments to calculate loss damages 3.3 Assess fairly and impartially validity of loss situation and/or claims against assessment data, and analyse against reported circumstances, available evidence, facts and information 3.4 Review insurance cover and policy conditions to ensure loss falls within policy coverage |
4. Report results | 4.1 Document and report assessment actions, procedures and outcomes, and record promptly and accurately 4.2 Ensure reporting includes recommendations on validity of claim and recovery amounts in relation to assessment and other relevant data 4.3 Provide stakeholders with accurate and timely advice regarding financial, medical or psychological assessment for claim proceedings |
Evidence of Performance
Evidence of the ability to:
interpret and identify circumstances in which specialist assistance should be sought for the resolution of a claim
correctly analyse claims information to determine the need for specialist assistance
engage specialist assistance as appropriate
monitor the specialist assessment activity
interpret and report on the outcomes of the advice in relation to the claim.
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:
describe methods, practices and guidelines for performing data analysis
describe ‘claims management’ as it applies to specialist circumstances
identify policy coverage and requirements
outline the principles of cost estimating in claims assessments
identify and explain key features of relevant legislation, regulatory guidelines and industry sector codes of practice
explain the roles and responsibilities of financial, medical and psychological specialists
describe the types and/or categories of insurance policies associated with financial, medical and psychological claims
describe analysis tools used to assess financial, medical and/or psychological assessments to calculate loss damages.
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, 1.2, 2.2, 3.1, 3.3, 3.4 | Analyses and consolidates information from a variety of different sources to identify inconsistencies and potential fraud Collates and interprets complex documentation and reviews specific data |
Writing | 2.1, 2.2, 4.1, 4.2, 4.3 | Accurately records and completes organisational documents and correspondence using clear language and correct spelling, grammar and terminology |
Oral Communication | 1.2, 2.1, 4.1, 4.3 | Interacts effectively in verbal exchanges, using active listening and questioning to convey and clarify information |
Numeracy | 3.1, 3.2, 3.3, 4.2 | Performs mathematical calculations to check, interpret and confirm numerical information |
Interact with others | 1.2, 2.1, 2.2, 4.1, 4.3 | Selects and uses appropriate conventions and protocols when communicating with clients and co-workers in a range of work contexts |
Get the work done | 1.1, 1.2, 2.1, 2.2, 3.1-3.4, 4.3 | Accepts responsibility for planning and sequencing 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 Applies systematic and analytical decision-making processes for complex situations Uses digital technologies to access, enter and store information required to complete work tasks |
Sectors
Insurance services