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Evidence Guide: FNSISV306 - Receive and record or register a claim

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

 

FNSISV306 - Receive and record or register a claim

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

Receive notification of claim

  1. Advise customer of claims procedure
  2. Give customer comprehensive information on organisation’s claims procedure, how to make a claim and send any forms required for claim to customer
  3. Answer customer queries clearly and accurately
Advise customer of claims procedure

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Give customer comprehensive information on organisation’s claims procedure, how to make a claim and send any forms required for claim to customer

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Answer customer queries clearly and accurately

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Receive claim

  1. Check new claims advice to verify correct policy detail
  2. Check claims records to ensure that claim has not been registered previously
Check new claims advice to verify correct policy detail

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Check claims records to ensure that claim has not been registered previously

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Record or register claim

  1. Accurately enter claims data and register claims in accordance with organisational procedures and level of authority
  2. Notify government authorities in correct format, where necessary
Accurately enter claims data and register claims in accordance with organisational procedures and level of authority

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Notify government authorities in correct format, where necessary

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Estimate claims reserve, including reinsurance as appropriate

  1. Calculate or estimate where appropriate the preliminary reserve according to organisational reserving policy
  2. For a routine claim, make a determination on acceptance or referral of claim in accordance with organisational policy and procedures
  3. Identify need for internal or external service providers, if appropriate
  4. Check policy for reinsurance details, if applicable
  5. Advise reinsurers of potential claim, if applicable, by raising reinsurance advice
  6. Report potential impact of claim on premium as required
Calculate or estimate where appropriate the preliminary reserve according to organisational reserving policy

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

For a routine claim, make a determination on acceptance or referral of claim in accordance with organisational policy and procedures

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify need for internal or external service providers, if appropriate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Check policy for reinsurance details, if applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Advise reinsurers of potential claim, if applicable, by raising reinsurance advice

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Report potential impact of claim on premium as required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Create claim files or add information to existing files

  1. File correspondence in correct claims files and allocate to relevant claims operatives
  2. Refer all missing information, abnormalities or classification uncertainties according to organisational policy
  3. Enter appropriate date into diary system, where necessary
  4. Complete all information accurately and clearly, and in accordance with legislative and organisational requirements
  5. File or refer completed documentation for processing if appropriate
File correspondence in correct claims files and allocate to relevant claims operatives

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Refer all missing information, abnormalities or classification uncertainties according to organisational policy

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Enter appropriate date into diary system, where necessary

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Complete all information accurately and clearly, and in accordance with legislative and organisational requirements

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

File or refer completed documentation for processing if appropriate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Receive notification of claim

1.1 Advise customer of claims procedure

1.2 Give customer comprehensive information on organisation’s claims procedure, how to make a claim and send any forms required for claim to customer

1.3 Answer customer queries clearly and accurately

2. Receive claim

2.1 Check new claims advice to verify correct policy detail

2.2 Check claims records to ensure that claim has not been registered previously

3. Record or register claim

3.1 Accurately enter claims data and register claims in accordance with organisational procedures and level of authority

3.2 Notify government authorities in correct format, where necessary

4. Estimate claims reserve, including reinsurance as appropriate

4.1 Calculate or estimate where appropriate the preliminary reserve according to organisational reserving policy

4.2 For a routine claim, make a determination on acceptance or referral of claim in accordance with organisational policy and procedures

4.3 Identify need for internal or external service providers, if appropriate

4.4 Check policy for reinsurance details, if applicable

4.5 Advise reinsurers of potential claim, if applicable, by raising reinsurance advice

4.6 Report potential impact of claim on premium as required

5. Create claim files or add information to existing files

5.1 File correspondence in correct claims files and allocate to relevant claims operatives

5.2 Refer all missing information, abnormalities or classification uncertainties according to organisational policy

5.3 Enter appropriate date into diary system, where necessary

5.4 Complete all information accurately and clearly, and in accordance with legislative and organisational requirements

5.5 File or refer completed documentation for processing if appropriate

Required Skills and Knowledge

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Receive notification of claim

1.1 Advise customer of claims procedure

1.2 Give customer comprehensive information on organisation’s claims procedure, how to make a claim and send any forms required for claim to customer

1.3 Answer customer queries clearly and accurately

2. Receive claim

2.1 Check new claims advice to verify correct policy detail

2.2 Check claims records to ensure that claim has not been registered previously

3. Record or register claim

3.1 Accurately enter claims data and register claims in accordance with organisational procedures and level of authority

3.2 Notify government authorities in correct format, where necessary

4. Estimate claims reserve, including reinsurance as appropriate

4.1 Calculate or estimate where appropriate the preliminary reserve according to organisational reserving policy

4.2 For a routine claim, make a determination on acceptance or referral of claim in accordance with organisational policy and procedures

4.3 Identify need for internal or external service providers, if appropriate

4.4 Check policy for reinsurance details, if applicable

4.5 Advise reinsurers of potential claim, if applicable, by raising reinsurance advice

4.6 Report potential impact of claim on premium as required

5. Create claim files or add information to existing files

5.1 File correspondence in correct claims files and allocate to relevant claims operatives

5.2 Refer all missing information, abnormalities or classification uncertainties according to organisational policy

5.3 Enter appropriate date into diary system, where necessary

5.4 Complete all information accurately and clearly, and in accordance with legislative and organisational requirements

5.5 File or refer completed documentation for processing if appropriate

Evidence of the ability to:

obtain claim information from customer and check details

record claims following relevant organisational operating procedures, legislative requirements and industry codes of practice

prepare claim costing and confirm its compliance with policies and procedures

complete documentation and data entry, ensuring accuracy, attention to detail and thorough checking

communicate outcome of claims with customer and others as appropriate

record and file relevant documentation and information.

Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.

To complete the unit requirements safely and effectively, the individual must:

explain the information technology and communications systems used in processing insurance claims

explain the wording of insurance policies in terms of organisational and departmental policy, procedures and authorities

explain the purpose, principles and methods of filing documentation

identify and describe the organisation’s insurance products available to customers, including any conditions and terms of reinsurance

outline relevant legislation, regulations, organisational policy and procedures for underwriting and levels of authority

explain the basics of reinsurance with respect to claims.