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Evidence Guide: FNSISV307 - Follow organisation procedures to process 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

 

FNSISV307 - Follow organisation procedures to process claim

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

Receive and clarify claim information

  1. Receive and record information relating to claim accurately onto system
  2. Advise customer of organisational claims procedures and respond to queries courteously and accurately
  3. Verify completeness of information
  4. Analyse all information against legislative requirements and organisational guidelines to decide for or against liability
  5. Determine whether claim is routine and fully covered by policy
  6. Pass claims not completely routine and within policy guidelines to appropriate staff
  7. Communicate information which potentially impacts on future renewal of policy or renewal terms promptly to underwriter or other appropriate staff in keeping with organisational policy
Receive and record information relating to claim accurately onto system

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Advise customer of organisational claims procedures and respond to queries courteously and accurately

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Verify completeness of information

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Analyse all information against legislative requirements and organisational guidelines to decide for or against liability

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Determine whether claim is routine and fully covered by policy

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Pass claims not completely routine and within policy guidelines to appropriate staff

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Communicate information which potentially impacts on future renewal of policy or renewal terms promptly to underwriter or other appropriate staff in keeping with organisational policy

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Determine acceptability of claim

  1. Determine acceptability of claim against policy specifications
  2. Check reinsurance coverage
  3. Refer queries on facts or valid acceptance of claim to specialists for advice, where required
Determine acceptability of claim against policy specifications

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Check reinsurance coverage

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Refer queries on facts or valid acceptance of claim to specialists for advice, where required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Accept or reject claim

  1. Process claim within required timeframes and according to organisational guidelines
  2. Use effective decision-making process to accept or reject claims within timeframes in accordance with legislation, organisational policy and procedures, and codes of practice as applicable
  3. Observe referral procedures where claim amounts are outside claims settlement and/or claims management authorities
  4. Make decision on liability in light of need to withstand scrutiny in subsequent proceedings
Process claim within required timeframes and according to organisational guidelines

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Use effective decision-making process to accept or reject claims within timeframes in accordance with legislation, organisational policy and procedures, and codes of practice as applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Observe referral procedures where claim amounts are outside claims settlement and/or claims management authorities

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Make decision on liability in light of need to withstand scrutiny in subsequent proceedings

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Process claim

  1. Register claim and process promptly in accordance with organisational guidelines and procedures
  2. Pass payment information on to appropriate staff, where required
  3. Inform customer of progress of claim
  4. Record all claim information accurately
Register claim and process promptly in accordance with organisational guidelines and procedures

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Pass payment information on to appropriate staff, where required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Inform customer of progress of claim

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Record all claim information accurately

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Document liability decisions

  1. Communicate liability decisions clearly to the relevant parties in a manner required by legislation, operating procedures and codes of practice as applicable
  2. Communicate reasons for decisions promptly to customer and other relevant parties
  3. Document decisions to demonstrate basis on which decision was reached and all evidence and/or information that was considered, where appropriate
  4. File documentation regarding decision according to organisational policy and procedure
Communicate liability decisions clearly to the relevant parties in a manner required by legislation, operating procedures and codes of practice as applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Communicate reasons for decisions promptly to customer and other relevant parties

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Document decisions to demonstrate basis on which decision was reached and all evidence and/or information that was considered, where appropriate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

File documentation regarding decision according to organisational policy and procedure

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 and clarify claim information

1.1 Receive and record information relating to claim accurately onto system

1.2 Advise customer of organisational claims procedures and respond to queries courteously and accurately

1.3 Verify completeness of information

1.4 Analyse all information against legislative requirements and organisational guidelines to decide for or against liability

1.5 Determine whether claim is routine and fully covered by policy

1.6 Pass claims not completely routine and within policy guidelines to appropriate staff

1.7 Communicate information which potentially impacts on future renewal of policy or renewal terms promptly to underwriter or other appropriate staff in keeping with organisational policy

2. Determine acceptability of claim

2.1 Determine acceptability of claim against policy specifications

2.2 Check reinsurance coverage

2.3 Refer queries on facts or valid acceptance of claim to specialists for advice, where required

3. Accept or reject claim

3.1 Process claim within required timeframes and according to organisational guidelines

3.2 Use effective decision-making process to accept or reject claims within timeframes in accordance with legislation, organisational policy and procedures, and codes of practice as applicable

3.3 Observe referral procedures where claim amounts are outside claims settlement and/or claims management authorities

3.4 Make decision on liability in light of need to withstand scrutiny in subsequent proceedings

4. Process claim

4.1 Register claim and process promptly in accordance with organisational guidelines and procedures

4.2 Pass payment information on to appropriate staff, where required

4.3 Inform customer of progress of claim

4.4 Record all claim information accurately

5. Document liability decisions

5.1 Communicate liability decisions clearly to the relevant parties in a manner required by legislation, operating procedures and codes of practice as applicable

5.2 Communicate reasons for decisions promptly to customer and other relevant parties

5.3 Document decisions to demonstrate basis on which decision was reached and all evidence and/or information that was considered, where appropriate

5.4 File documentation regarding decision according to organisational policy and procedure

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 and clarify claim information

1.1 Receive and record information relating to claim accurately onto system

1.2 Advise customer of organisational claims procedures and respond to queries courteously and accurately

1.3 Verify completeness of information

1.4 Analyse all information against legislative requirements and organisational guidelines to decide for or against liability

1.5 Determine whether claim is routine and fully covered by policy

1.6 Pass claims not completely routine and within policy guidelines to appropriate staff

1.7 Communicate information which potentially impacts on future renewal of policy or renewal terms promptly to underwriter or other appropriate staff in keeping with organisational policy

2. Determine acceptability of claim

2.1 Determine acceptability of claim against policy specifications

2.2 Check reinsurance coverage

2.3 Refer queries on facts or valid acceptance of claim to specialists for advice, where required

3. Accept or reject claim

3.1 Process claim within required timeframes and according to organisational guidelines

3.2 Use effective decision-making process to accept or reject claims within timeframes in accordance with legislation, organisational policy and procedures, and codes of practice as applicable

3.3 Observe referral procedures where claim amounts are outside claims settlement and/or claims management authorities

3.4 Make decision on liability in light of need to withstand scrutiny in subsequent proceedings

4. Process claim

4.1 Register claim and process promptly in accordance with organisational guidelines and procedures

4.2 Pass payment information on to appropriate staff, where required

4.3 Inform customer of progress of claim

4.4 Record all claim information accurately

5. Document liability decisions

5.1 Communicate liability decisions clearly to the relevant parties in a manner required by legislation, operating procedures and codes of practice as applicable

5.2 Communicate reasons for decisions promptly to customer and other relevant parties

5.3 Document decisions to demonstrate basis on which decision was reached and all evidence and/or information that was considered, where appropriate

5.4 File documentation regarding decision according to organisational policy and procedure

Evidence of the ability to:

accurately process claims across a representative range of products, customers and conditions in accordance with legislation, regulations and organisational policy by:

receiving, recording and clarifying the claim information

making a determination on claim approval

notifying the customer of claim and payment outcomes

documenting and communicating outcomes to relevant parties.

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:

state the accountability requirements of individuals involved with insurance claims and identify the level at which claims should be referred to senior staff

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

outline key features of organisational policy and procedures, and legislation, regulation and codes of practice relating to processing insurance claims

identify the rationale and principles of filing

identify and describe the organisation’s insurance products available to customers, including any conditions and terms for making claims.