Evaluate life insurance claims

Unit of competency Outline

Date retreived
23/07/2026 1:12 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.

Unit of competency

National Code
FNSILF415

State Code
ODR89

TGA Status
Current

DTWD Status
Approved

Current Release Number
1.00

Current Release Date
27/01/2022

View on TGA

State Implementation and Classification

Approved Date

08/04/2022

Field of Education

081103 - Insurance And Actuarial Studies

Original Release Date

08/04/2022

Nominal Hours

Description

This unit describes the skills and knowledge required to handle the receipt, initial assessment and processing of claims made under risk-based life insurance policies.The unit applies to claims assessors who work in claims management in life insurance contexts.No licensing, legislative or certification requirements apply to this unit at the time of publication.

Notes

Elements and Performance Criteria

1. Process claim information

1.1 Receive and file claim information
1.2 Summarise information in assessment notes according to organisational policies and procedures
1.3 Check that documentation is correct and complete according to legislative and regulatory requirements

2. Evaluate claim information

2.1 Determine the authority level required to evaluate the claim
2.2 Analyse information and evidence against policy terms and conditions according to organisational policies and procedures
2.3 Determine if policy terms and conditions are met
2.4 Identify whether policy exclusions apply
2.5 Analyse information on file, identify gaps and request additional information as required and according to code of professional practice and code of ethics
2.6 Refer assessment of application and file to appropriate authority for approval if required, according to organisational policies and procedures

3. Establish liability for payment

3.1 Determine authority level required to establish liability, and refer decision and rationale with claim file to appropriate authority if necessary, according to organisational policies and procedures
3.2 Determine whether claim can be admitted and whether payment is required according to organisational policies and procedures and within authority limits
3.3 Calculate and process payment according to organisational policies and procedures, as required
3.4 Communicate outcomes to required parties according to organisational policies and procedures
3.5 Update policy, claim records and file documentation according to organisational policies and procedures

4. Close claim

4.1 Confirm required documentation for the claim is stored in claim file according to organisational policies and procedures
4.2 Confirm required medical, financial and closure fields are completed in claims system according to organisational policies and procedures
4.3 Confirm all policy records are updated in policy administration system according to organisational policies and procedures
4.4 Update claim information in required systems according to organisational policies and procedures
4.5 Advise policy owner or authorised parties of status of claim according to organisational policies and procedures

No information

Replaces

State Code	National Code	Title	Type
AUR70	FNSILF405	Evaluate life insurance claims	Unit of competency

State Code	National Code	Title	Type
BHK4	FNS41521	Certificate IV in Life Insurance	Qualification
AE665	FNSSS00019	Life Insurance Claims Handling Skill Set	Skill set