Unit of competency Outline
Date retreived
22/07/2026 2:36 PM AWST
22/07/2026 2:36 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.
Use specialist terminology in insurance claims
Use specialist terminology in insurance claims
Unit of competency
National Code
FNSISV406A
FNSISV406A
State Code
D4238
D4238
TGA Status
Replaced
Replaced
DTWD Status
Replaced
Replaced
State Implementation and Classification
Approved Date
29/07/2014
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
29/07/2014
Nominal Hours
30
Description
This unit describes the performance outcomes, skills and knowledge required to understand, use and respond to information involving specialist terminology, such as medical or legal terminology (and processes), in insurance claims.This unit is applicable to individuals working within enterprises and job roles subject to licensing, legislative, regulatory or certification requirements including legislation administered by the Australian Securities and Investments Commission (ASIC).
Notes
Elements and Performance Criteria
1. Interpret documents and instructions which contain specialist insurance terminology
- 1.1. Written and oral instructions for a claim, using specialist terminology, are received, understood and documented
- 1.2. Claims documentation containing specialist terminology is accurately interpreted
- 1.3. Checklists and sources of information for specialist terminology used in claims are used where appropriate
- 1.4. Abbreviations for specialist terms and related processes associated with insurance claims are understood
- 1.5. Clarification is sought when necessary
2. Use appropriate specialist terminology in written and oral communication related to a claim
- 2.1. Appropriate specialist terminology is used in both written and oral communication with internal and external parties related to a claim
- 2.2. Specialist terminology related to insurance claims is spelt and pronounced correctly and used in appropriate context
- 2.3. Claims documentation is presented to a designated person for verification, if required
3. Apply specialist terminology to claims tasks
- 3.1. Specialist terminology is used correctly in the completion of insurance claims tasks
- 3.2. Assistance or clarification is sought from specialist representatives or designated person as required
- 3.3. All tasks are conducted within accepted organisation and ethical codes of conduct including those relating to maintaining confidentiality, privacy and compliance
4. Extend understanding of specialist terminology
- 4.1. Gaps in knowledge, such as relevant legislation, are identified and clarification is sought through appropriate source or person
- 4.2. Abbreviations for commonly used specialist terms and associated processes for insurance claims are identified and used where appropriate
- 4.3. Questions relating to specialist terminology used in insurance can be answered and terms defined
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.
Written and oral instructions may include:
notices
telephone calls
terms and conditions of claim
verbal instructions
written advice.
Commonly used/appropriate specialist terminology in insurance may relate to:
legislation and regulations
insurance policy and claims documentation
risk management policies and practices
legal terminology:
courts and tribunals
legal personnel
legal systems, processes and procedures
legal documentation
abbreviations for legal terms
legal terminology in insurance may vary according to:
the area of law
legal system/country to which claim relates
a particular legal procedure
the jurisdiction
the type of policy or coverage
medical terminology:
knowledge of medical specialties and the names and titles of doctors working in specialist fields
illnesses
injuries
diseases
interrelated functions of the body, locations and diseases (e.g. functions of the skeletal system, locations of skeletal injuries, skeletal diseases)
terms to describe onset and/or nature of disease
medical conditions
medical investigations and procedures
abbreviations for medical and pharmacological terms
medical equipment and instruments
departments/sections in a hospital
medications
health insurance or WorkCover terminology
Medicare terminology
referrals.
Claims documentation may include:
case reports
correspondence to a range of medical/hospital/legal professionals on claimant related matters
database information
files
forms
insurance policy documents and coverage details
letters
minutes
telephone messages
medical documentation:
claimant medical history
claimant medical records
routine medical reports associated with the claim
claimant test results.
Assistance or clarification may be sought from:
organisation policy, procedures and guidelines
insurance information/databases
claims manager/specialist or designated supervisor
underwriter or underwriting specialist/manager
other designated person/s
medical terminology clarification/assistance:
medical dictionary
medical information sources/databases
legal terminology clarification/assistance:
legal dictionary
glossary of commonly use legal terminology and processes used in insurance claims
legal team representatives.
Specialist representatives or designated person may include:
claims manager/specialist or designated supervisor
legal team representative
underwriter or underwriting specialist/manager
WorkCover or specialist medical representative.
Tasks may include:
contacting relevant internal or external parties
dealing with enquiries
drafting letters in response to claims case queries
maintenance/update of claims files and databases (e.g. file notes, correspondence, reports)
producing memos, reports
medical terminology related claims tasks:
research/arranging medical or psychological assessments for claim
legal terminology related claims tasks:
research for claim and related legal proceedings
preparing documentation to support legal proceedings
providing verbal and/or written advice and information on the status of legal proceedings for a claim.
Compliance may include:
all activities covered in this unit to be undertaken in line with the relevant current:
legislation
regulations
organisation operating procedures
codes of practice, where applicable.
Relevant legislation may include:
building or construction
Consumer Credit Code
contract law
environmental
hazardous materials
industry codes of practice
Insurance Agents and Brokers Act
Insurance Contracts Act
motor vehicle
occupational health and safety (OHS)
Privacy Act
Statutes of limitations
secrecy laws
Trade Practices Act.
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.
Written and oral instructions may include:
notices
telephone calls
terms and conditions of claim
verbal instructions
written advice.
Commonly used/appropriate specialist terminology in insurance may relate to:
legislation and regulations
insurance policy and claims documentation
risk management policies and practices
legal terminology:
courts and tribunals
legal personnel
legal systems, processes and procedures
legal documentation
abbreviations for legal terms
legal terminology in insurance may vary according to:
the area of law
legal system/country to which claim relates
a particular legal procedure
the jurisdiction
the type of policy or coverage
medical terminology:
knowledge of medical specialties and the names and titles of doctors working in specialist fields
illnesses
injuries
diseases
interrelated functions of the body, locations and diseases (e.g. functions of the skeletal system, locations of skeletal injuries, skeletal diseases)
terms to describe onset and/or nature of disease
medical conditions
medical investigations and procedures
abbreviations for medical and pharmacological terms
medical equipment and instruments
departments/sections in a hospital
medications
health insurance or WorkCover terminology
Medicare terminology
referrals.
Claims documentation may include:
case reports
correspondence to a range of medical/hospital/legal professionals on claimant related matters
database information
files
forms
insurance policy documents and coverage details
letters
minutes
telephone messages
medical documentation:
claimant medical history
claimant medical records
routine medical reports associated with the claim
claimant test results.
Assistance or clarification may be sought from:
organisation policy, procedures and guidelines
insurance information/databases
claims manager/specialist or designated supervisor
underwriter or underwriting specialist/manager
other designated person/s
medical terminology clarification/assistance:
medical dictionary
medical information sources/databases
legal terminology clarification/assistance:
legal dictionary
glossary of commonly use legal terminology and processes used in insurance claims
legal team representatives.
Specialist representatives or designated person may include:
claims manager/specialist or designated supervisor
legal team representative
underwriter or underwriting specialist/manager
WorkCover or specialist medical representative.
Tasks may include:
contacting relevant internal or external parties
dealing with enquiries
drafting letters in response to claims case queries
maintenance/update of claims files and databases (e.g. file notes, correspondence, reports)
producing memos, reports
medical terminology related claims tasks:
research/arranging medical or psychological assessments for claim
legal terminology related claims tasks:
research for claim and related legal proceedings
preparing documentation to support legal proceedings
providing verbal and/or written advice and information on the status of legal proceedings for a claim.
Compliance may include:
all activities covered in this unit to be undertaken in line with the relevant current:
legislation
regulations
organisation operating procedures
codes of practice, where applicable.
Relevant legislation may include:
building or construction
Consumer Credit Code
contract law
environmental
hazardous materials
industry codes of practice
Insurance Agents and Brokers Act
Insurance Contracts Act
motor vehicle
occupational health and safety (OHS)
Privacy Act
Statutes of limitations
secrecy laws
Trade Practices Act.
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:
interpret instructions containing commonly used specialist terminology and abbreviations are responded to appropriately
maintain knowledge of specialist terminology used in insurance
use specialist terminology in insurance appropriately for the situation
access an appropriate person/source of information to clarify unclear instructions or to locate missing information
explain specialist terminology and processes applied to insurance to others in simple, non-specialist language with non-disclosable information is not communicated
understand legal and financial consequences of misusing legal terminology
conduct all work within accepted organisation and ethical codes of conduct including those relating to maintaining confidentiality, privacy and compliance.
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 organisation records
access to organisation policies and procedures.
Method of assessment
A range of assessment methods should be used to assess practical skills and knowledge. The following examples, in combination, 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.
Guidance information for assessment
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:
interpret instructions containing commonly used specialist terminology and abbreviations are responded to appropriately
maintain knowledge of specialist terminology used in insurance
use specialist terminology in insurance appropriately for the situation
access an appropriate person/source of information to clarify unclear instructions or to locate missing information
explain specialist terminology and processes applied to insurance to others in simple, non-specialist language with non-disclosable information is not communicated
understand legal and financial consequences of misusing legal terminology
conduct all work within accepted organisation and ethical codes of conduct including those relating to maintaining confidentiality, privacy and compliance.
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 organisation records
access to organisation policies and procedures.
Method of assessment
A range of assessment methods should be used to assess practical skills and knowledge. The following examples, in combination, 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.
Guidance information for assessment
Replaced By
| State Code | National Code | Title | Type |
|---|---|---|---|
| AUS07 | FNSISV406 | Use specialist terminology in insurance claims | Unit of competency |
| State Code | National Code | Title | Type |
|---|---|---|---|
| D713 | FNS41411 | Certificate IV in General Insurance | Qualification |
| D775 | FNS41512 | Certificate IV in Life Insurance | Qualification |
| D776 | FNS51312 | Diploma of Life Insurance | Qualification |