Unit of competency Outline

Date retreived
22/07/2026 10:28 PM AWST

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Follow organisation procedures to process claim

Follow organisation procedures to process claim

Unit of competency
National Code
FNSISV307
State Code
AUS08
TGA Status
Deleted
DTWD Status
Deleted
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
10
Description
This unit describes the skills and knowledge required to process an insurance claim in accordance with organisational guidelines and procedures.It applies to individuals employed in a range of insurance sectors and may be applied within organisations of various sizes and across a range of customer bases.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. 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
No information
No information
Replaces
State Code National Code Title Type
D4229 FNSISV307A Follow organisation procedures to process claim Unit of competency
State Code National Code Title Type
AVZ8 FNS30515 Certificate III in General Insurance Qualification