Elements and Performance Criteria

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.


manual checklists or through data entry validation on computer systems and may include:
previous payment to claimant
claim has been sent to the wrong insurer
liability has not been accepted


coding according to organisation requirements (entering statistical data)


entering claims reserve/estimate

observing limits to authority level

recording in system

linking to relative policy

identifying interested parties

identifying reinsurance involvement


initiation of new claims and processing of claims

correspondence presentation

security procedures


a written policy and procedures manuals that define the level of authority to make decisions on claims within the organisation

guidelines/procedures relating to injury management and use of service providers


computerised, and record updating may be by electronic or manual data recording


assessors

investigators

private investigators

medical advisers

surveyors

engineers

accountants

auditors

and others as required


check specific treaty and/or facultative coverage for catastrophic claims and allocate internal category code


notifying the reinsurer of potential claim (if appropriate) by raising a credit/debit note


legislation

regulations

organisation operating procedures

codes of practice, where applicable


State and Territory Workers Compensation Act and regulations

taxation legislation

Privacy Act

social security legislation

health and other services (compensation) acts

industrial relations legislation

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

To achieve competency in this unit, a person must be able to demonstrate:

full compliance with organisation operating procedures, legislative requirements and industry codes of practice
accuracy and attention to detail and thorough checking of data

Evidence required for demonstration of consistent performance:
Competence in this unit must be assessed over a period of time in order to ensure consistency of performance over the Range Statement and contexts applicable to the work environment.

Delivery/assessment relationship to other units:
This unit can be assessed independently, however it may be assessed with other appropriate units such as:
FNSINSV307B Follow organisation procedures to process claim
FNSINSV405B Analyse insurance claims
FNSINSV309B Settle claims
FNSINSV507B Implement claim recovery procedures
FNSINSV508B Review claims settlement policies and procedures.
Consideration should be given to implications on the qualification structure if assessing with the above listed units.

Method of assessment:
For valid and reliable assessment of this unit, evidence should be gathered through a range of methods to indicate consistent performance.
Assessment of this unit of competence will usually include observation of processes and procedures, oral and/or written questioning on underpinning knowledge and skills to ensure knowledge principles are both known and applied. Other methods such as case study and analysis, workplace records/documentation review, may be used as required.

Context of assessment:
Assessment of performance requirements in this unit should be undertaken within the general insurance industry context and should cover aspects of personal/financial responsibility and accountability.
Aspects of competency, including the attainment of relevant knowledge and skills, may be assessed in a relevant workplace, a closely simulated work environment, or other appropriate means that clearly meet industry competency requirements.

Resources required for assessment:
Unless otherwise specified, there are no significant resource implications for assessment of this unit, apart from access to a relevant workplace or closely simulated office environment and the use of a range of office equipment, technology and consumables. These may include routine commercial computer hardware, software, telephones, facsimiles, and other relevant office equipment.