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Evidence Guide: FNSILF405A - Evaluate life insurance claims

Student: __________________________________________________

Signature: _________________________________________________

Tips for gathering evidence to demonstrate your skills

The important thing to remember when gathering evidence is that the more evidence the better - that is, the more evidence you gather to demonstrate your skills, the more confident an assessor can be that you have learned the skills not just at one point in time, but are continuing to apply and develop those skills (as opposed to just learning for the test!). Furthermore, one piece of evidence that you collect will not usualy demonstrate all the required criteria for a unit of competency, whereas multiple overlapping pieces of evidence will usually do the trick!

From the Wiki University

 

FNSILF405A - Evaluate life insurance claims

What evidence can you provide to prove your understanding of each of the following citeria?

Receive claim form

  1. Receive claim form and compile necessary documentation
  2. Review policy details to ensure valid cover is in force
  3. Establish that the claimant is authorised to deal with the policy
  4. Check that documentation is correct and complete
  5. Determine authority level required to evaluate the claim and refer application to appropriate authority as necessary
Receive claim form and compile necessary documentation

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Review policy details to ensure valid cover is in force

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Establish that the claimant is authorised to deal with the policy

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Check that documentation is correct and complete

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Determine authority level required to evaluate the claim and refer application to appropriate authority as necessary

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Evaluate claim information

  1. Identify and review evidence against payment criteria
  2. Check whether the terms and conditions of the policy have been verifiably met
  3. Identify whether policy exclusions apply
  4. Seek additional specialist advice as appropriate
  5. Recognise where information suggests unresolved complexity and seek further information as appropriate
Identify and review evidence against payment criteria

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Check whether the terms and conditions of the policy have been verifiably met

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify whether policy exclusions apply

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Seek additional specialist advice as appropriate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Recognise where information suggests unresolved complexity and seek further information as appropriate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Establish liability for payment

  1. Determine whether claim can be admitted in accordance with procedures and within authority limits
  2. Make payment recommendation in accordance with procedures
  3. Communicate outcomes to all relevant parties in accordance with procedures
  4. Update records and file documentation in accordance with procedures and regulatory requirements
Determine whether claim can be admitted in accordance with procedures and within authority limits

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Make payment recommendation in accordance with procedures

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Communicate outcomes to all relevant parties in accordance with procedures

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Update records and file documentation in accordance with procedures and regulatory requirements

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

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 evaluation 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 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

Required Skills and Knowledge

Required skills

communication skills to:

to gather and check information

liaise and share information with others

communicate appropriately with people from diverse backgrounds

IT skills to:

use computer applications (word processing, spreadsheet, database, specific purpose computer systems)

access and update records electronically

numeracy skills to:

calculate life insurance payments

organisational skills to efficiently plan and sequence work

problem solving skills to address errors in life insurance documentation

reading skills to:

read and understand relevant procedures

read and understand life insurance policies

read and interpret life insurance claims and supporting 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 initial evaluation 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.

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.

Documentation may include:

financial records

other medical records

records of birth

records of death

records of disablement

statutory declarations and other such records.

Valid cover may include:

policy is current

premiums are up to date.

Appropriate authority may include:

supervisor

manager

other levels of management.

Payment criteria may include evidence of:

death (including terminal illness)

invalidity (permanent or temporary disability)

trauma.

Policy exclusions may include:

geographical location

high risk activities

medical conditions

pre-existing illnesses.

Specialist advice may include:

accountants

administrators

investigation agencies

Chief Medical Officers

trustees

underwriters

government regulators

Australian Securities and Investments Commission (ASIC)

Australian Tax Office (ATO).

Unresolved complexity may include indicators of possible:

fraud

misrepresentation

non-disclosure.

Further information may include:

additional questionnaires

employment details

financial evidence

interviews

medical evidence

surveillance.

Procedures may include:

organisational complaints handling processes

organisational customer service charter

organisational guidelines

organisational policy

organisational privacy and confidentiality guidelines

organisational procedures.

Outcomes may include:

admit claim

amend claim

investigate claim

deny claim.

Relevant parties may include:

claimant

adviser

other relevant business teams.

Regulatory requirements may include:

Australian Securities and Investments Commission (ASIC) regulatory guides

corporations legislation

insurance contracts legislation

life insurance legislation

privacy legislation.