Unit of competency Outline

Date retreived
23/07/2026 1:05 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.

Analyse insurance claims

Analyse insurance claims

Unit of competency
National Code
FNSISV405A
State Code
D4237
TGA Status
Replaced
DTWD Status
Replaced
Current Release Number
1.00
Current Release Date
24/11/2010
View on TGA
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
60
Description
This unit describes the performance outcomes, skills and knowledge required to analyse insurance claims including researching and validating the claim information and maintaining records and lines of communication.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. Collect and organise information relating to claim
  • 1.1. All relevant information is obtained to determine whether a valid claim exists (liability)
  • 1.2. Relevant information is organised into a coherent and valid body of case knowledge
  • 1.3. Confidentiality of information is maintained according to legislative requirements and industry principles as appropriate
  • 1.4. Any information deficiencies are identified, and additional information is sought from appropriate sources
2. Research claim and validate claim information
  • 2.1. Claims information is checked to determine legitimacy of claim, including validity of the policy, and whether the claimant is eligible to claim on the policy
  • 2.2. Needs for investigation/further information are identified and appropriate service provider/s are appointed where necessary
  • 2.3. Information is provided to reinsurers, if applicable
  • 2.4. Investigation and research are undertaken within established claims management criteria and authorities
  • 2.5. Progress of investigation is monitored, if applicable
  • 2.6. All missing information, abnormalities or classification uncertainties are referred to an appropriate authority
3. Maintain records and lines of communication
  • 3.1. Regular contact is maintained with the relevant parties to ensure that they are aware of the current status of the claim and are actively participating in the process
  • 3.2. Information which impacts on the policy is communicated promptly to the underwriter
  • 3.3. Diary system is maintained regularly and accurately and timelines adhered to
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.
Liability may involve:
motor vehicle accident, dependency payments, journey/third party, pecuniary loss, loss of goods, weekly payments, medical expenses, death of a worker, claim made after worker ceases employment and others.
Service providers may include:
accountants
assessors
auditors
engineers
investigators
medical advisers
private investigators
surveyors
and others as required.
Relevant parties may include:
claims assessors
compensation authority
employer and industry associations
insurance brokers
investigators
legal service providers
medical and like providers
risk management consultants
self insurer
solicitors
the authorised insurer
the community
the customer
the employer
the worker
union
witnesses.
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 and comply with industry and organisation obligations and objectives
effectively analyse and interpret data.

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
C9842 FNSINSV405B Analyse insurance claims Unit of competency
Replaced By
State Code National Code Title Type
AUX01 FNSISV405 Analyse insurance claims Unit of competency