Unit of competency Outline

Date retreived
23/07/2026 7:39 AM 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.

Manage handling and settlement of routine insurance claims for retail clients

Manage handling and settlement of routine insurance claims for retail clients

Unit of competency
National Code
FNSISV408
State Code
OCI53
TGA Status
Current
DTWD Status
Approved
Current Release Number
1.00
Current Release Date
04/11/2020
View on TGA
State Implementation and Classification
Approved Date
11/03/2021
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
11/03/2021
Nominal Hours
45
Description
This unit describes the skills and knowledge required to handle routine retail insurance claims. It includes organising and analysing information to establish probable cause and policy coverage, determining the quantum of claims, and assessing settlement options.The unit applies to those who use well-developed interpersonal, analytical and communication skills in organisations of various sizes and across a range of retail insurance customer bases.Work functions in the occupational areas where this unit may be used are subject to regulatory requirements. Users are advised to check with the relevant state and territory regulatory authorities to confirm those requirements.
Notes
Elements and Performance Criteria
1. Analyse insurance claim to determine validity
  • 1.1 Source and analyse information, and check its accuracy and completeness
  • 1.2 Determine and evaluate probable cause, parties to the claim, insurable interest, additional information requirements, and if loss assessor is required
  • 1.3 Evaluate application of relevant statutory and common law principles relevant to claim
  • 1.4 Confirm insured’s entitlement to cover based on terms and conditions of insurance policy
  • 1.5 Seek confirmation and/or approvals by required stakeholders
  • 1.6 Evaluate option to fast track claim in cases of financial hardship
  • 1.7 Identify suspicious, fraudulent and non-standard elements of claim
  • 1.8 Document decision, including evidence and information collected
2. Monitor progress of insurance claim
  • 2.1 Monitor provision of service provider reports according to relevant codes of practice
  • 2.2 Provide progress reports to the insured according to relevant codes of practice
  • 2.3 Liaise with internal and external stakeholders relevant to claim
3. Determine scope of insurance claim and settlement options
  • 3.1 Review information to identify scope of claim and deficiencies
  • 3.2 Determine extent of loss according to organisational policies and procedures
  • 3.3 Confirm insured and non-insured items
  • 3.4 Determine basis of settlement and settlement options according to terms and conditions of insurance contract
  • 3.5 Review recovery options and their impact on settlement of claim
  • 3.6 Obtain approval for basis of settlement, as required
4. Provide claims response to the insured
  • 4.1 Prepare or review statement of claim for offers of cash settlement in part or full, according to regulatory requirements and organisational policies and procedures
  • 4.2 Negotiate claim settlement with the insured
  • 4.3 Inform the insured of the internal complaints process and external dispute resolution process and of insured’s right to information
  • 4.4 Settle claim in line with the insured’s preferred settlement method
5. Finalise and document settlement decisions
  • 5.1 Confirm final payments were made to insured within required timeframes
  • 5.2 Document decisions and all evidence and information considered in determining claim according to organisational policies and procedures
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