Unit of competency Outline
Date retreived
22/07/2026 7:57 PM AWST
22/07/2026 7:57 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.
Follow organisation procedures to process claim
Follow organisation procedures to process claim
Unit of competency
National Code
FNSISV307A
FNSISV307A
State Code
D4229
D4229
TGA Status
Replaced
Replaced
DTWD Status
Replaced
Replaced
State Implementation and Classification
Approved Date
28/07/2014
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
28/07/2014
Nominal Hours
10
Description
This unit describes the performance outcomes, skills and knowledge required to process an insurance claim in accordance with organisation guidelines and procedures, including those needed to decide whether to accept or reject a claim by reviewing the data against organisation policy and procedures. It usually encompasses handling claims through information technology systems that contain information giving assistance and guidance to the operator.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. Receive and clarify claim information
- 1.1. Information relating to the claim is received and entered into the system accurately
- 1.2. Customer is advised of organisation claims procedures and queries are responded to courteously and accurately
- 1.3. Completeness of the information is checked
- 1.4. All information is analysed against legislative requirements and organisation guidelines to decide for or against liability
- 1.5. Determination is made as to whether the claim is routine and fully covered by the policy
- 1.6. Claims not completely routine and fully within the policy guidelines are passed on to appropriate staff
- 1.7. Information which potentially impacts in the future renewal of the policy or renewal terms is communicated promptly to the underwriter or other appropriate staff in keeping with organisational policy
2. Determine acceptability of claim
- 2.1. Acceptability of claim is determined against policy specifications
- 2.2. Reinsurance coverage is checked
- 2.3. Queries on facts or the valid acceptance of the claim are referred to specialists for advice where required
3. Accept or reject claim
- 3.1. Claim is processed within required timeframes and according to organisation guidelines
- 3.2. Correct acceptance or rejection decision is made using an effective decision making process within timeframes in accordance with legislation, organisation policy and procedures and codes of practice, as applicable
- 3.3. Referral procedures are observed where claim amounts are outside claims settlement and/or claims management authorities
- 3.4. Decision on liability is made in light of the need to withstand scrutiny in subsequent proceedings
4. Process claim
- 4.1. Claim is registered and processed promptly in accordance with organisation guidelines and procedures
- 4.2. Where required, payment information is passed on to appropriate staff
- 4.3. Customer is kept informed of progress of the claim
- 4.4. All claim information is accurately recorded
5. Document liability decisions
- 5.1. Liability decisions are clearly communicated to the relevant parties in a manner required by the legislation, operating procedures and codes of practice, as applicable
- 5.2. Reasons for decisions are communicated promptly to client and other relevant parties
- 5.3. Decisions are documented in such a way as to demonstrate the basis on which the decision was reached and all the evidence/information that was considered, where appropriate, and filed
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.
Claims information may include:
identifying data, policy, risk, previous history with the organisation.
Entering claims data may include:
coding according to organisation requirements (entering statistical data).
Systems may be:
computerised, and data recording and updating will be by electronic in the majority of cases.
Organisation procedures may include:
initiation of new claims and processing of fully routine claims
correspondence presentation
security procedures.
Claims checking may include:
manual checklists but in the majority of cases it will be 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
Specialists may include:
organisation specialists or outside service providers such as investigators, lawyers, accountants, medical practitioners, loss assessors.
Referral procedures may involve:
referral to the next authority level.
Registering claims may involve:
entering claims reserve/estimate, observing limits to authority level.
Decision making process may involve:
consultation
fact finding
research.
Files may be:
paper documents or electronic files.
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.
Claims information may include:
identifying data, policy, risk, previous history with the organisation.
Entering claims data may include:
coding according to organisation requirements (entering statistical data).
Systems may be:
computerised, and data recording and updating will be by electronic in the majority of cases.
Organisation procedures may include:
initiation of new claims and processing of fully routine claims
correspondence presentation
security procedures.
Claims checking may include:
manual checklists but in the majority of cases it will be 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
Specialists may include:
organisation specialists or outside service providers such as investigators, lawyers, accountants, medical practitioners, loss assessors.
Referral procedures may involve:
referral to the next authority level.
Registering claims may involve:
entering claims reserve/estimate, observing limits to authority level.
Decision making process may involve:
consultation
fact finding
research.
Files may be:
paper documents or electronic files.
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:
accurately process claims across a representative range of products, clients and conditions
apply organisation policy and procedures and comply with legislation and regulations and industry codes of practice.
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:
accurately process claims across a representative range of products, clients and conditions
apply organisation policy and procedures and comply with legislation and regulations and industry codes of practice.
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
Replaces
| State Code | National Code | Title | Type |
|---|---|---|---|
| C9834 | FNSINSV307B | Follow organisation procedures to process claim | Unit of competency |
Replaced By
| State Code | National Code | Title | Type |
|---|---|---|---|
| AUS08 | FNSISV307 | Follow organisation procedures to process claim | Unit of competency |
| State Code | National Code | Title | Type |
|---|---|---|---|
| D704 | FNS30511 | Certificate III in General Insurance | Qualification |