Manage non-routine and complex claims

Unit of competency Outline

Date retreived
22/07/2026 1:39 PM AWST

Whilst all efforts are made to provide accurate and timely information from the relevant source/documentation, please be aware that the information supplied may not be the most current version. The accuracy of the detail has not been confirmed by the Department and therefore should not be relied upon without first confirming the contents.

Unit of competency

National Code
FNSISV510

State Code
AUS21

TGA Status
Replaced

DTWD Status
Replaced

Current Release Number
1.00

Current Release Date
25/03/2015

View on TGA

State Implementation and Classification

Approved Date

16/09/2015

Field of Education

081103 - Insurance And Actuarial Studies

Original Release Date

16/09/2015

Nominal Hours

Description

This unit describes the skills and knowledge required to manage non-routine and complex insurance claims, including non-standard issues, determination of the business impact and managing all aspects of the claims resolution process.It applies to individuals working in job roles involving specialist knowledge and functions where skills are needed to manage non-routine and complex insurance claims such as major losses, bodily injury losses, long-term settlement and claims involving legal procedures across international boundaries.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.

Notes

Elements and Performance Criteria

1. Analyse claim to determine validity

1.1 Assess validity of claim against organisational and policy acceptance criteria for relevant type and category of policy
1.2 Confirm information as accurate, comprehensive and authentic
1.3 Seek inclusive validity from specialists for advice where required
1.4 Notify reinsurer of any claim immediately

2. Evaluate impact of claim

2.1 Analyse data relating to extent of loss, damage or injury, and seek and review claim estimates
2.2 Compare claim to expected payment projections for product type and determine business impact
2.3 Determine strategies to minimise negative impact of any non-routine or complex claim within requirements to meet policy obligations
2.4 Determine necessity for urgent action to protect organisational interests

3. Determine settlement options

3.1 Identify settlement options within policy obligations, organisational and legislative requirements
3.2 Seek advice on settlement options from appropriate person if required

4. Manage support arrangements to resolve claim

4.1 Liaise with relevant parties to identify and meet support requirements such as partnering with external experts to ensure clients’ needs are met
4.2 Manage any legal processes from non-routine or complex claims perspective, including international legal system requirements, if applicable
4.3 Employ mediation skills to resolve issues or disputes associated with significant claim, as required

5. Identify any required changes to policy or procedures

5.1 Document circumstances of claim for consideration in portfolio review
5.2 Instigate changes to policy and procedures to minimise further loss in similar circumstances, if appropriate

6. Report findings and update records

6.1 Document actions, procedures and outcomes and record promptly and accurately
6.2 Provide stakeholders with accurate and timely advice regarding claim proceedings
6.3 Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable

No information

Replaces

State Code	National Code	Title	Type
D4248	FNSISV510A	Manage non-routine and complex claims	Unit of competency

Replaced By

State Code	National Code	Title	Type
OCI44	FNSISV520	Manage non-routine and complex insurance claims	Unit of competency

State Code	National Code	Title	Type
AWE4	FNS51115	Diploma of General Insurance	Qualification