Unit of competency Outline

Date retreived
22/07/2026 11:32 PM AWST

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Investigate insurance claims

Investigate insurance claims

Unit of competency
National Code
FNSISV506
State Code
AUS29
TGA Status
Replaced
DTWD Status
Replaced
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
60
Description
This unit describes the skills and knowledge required to investigate an insurance claim. Investigation may cover the degree of liability or a potential fraud and covers clarifying the brief, conducting the investigation and reporting on the findings.It applies to individuals working in job roles involving specialist knowledge and functions including claims and underwriting in a range of insurance sectors and may be applied within organisations of various sizes and across a range of client 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. Clarify brief and instructions
  • 1.1 Clarify brief provided to investigator including facts of claim, insurer’s instructions and outcomes required
  • 1.2 Check subject matter questions to be investigated
2. Investigate claim
  • 2.1 Determine method of investigation
  • 2.2 Collect and organise required information to make logical case
  • 2.3 Carry out investigations in accordance with legislation, regulations and organisational operating procedures and codes of practice, if applicable
  • 2.4 Record all data and information progressively and accurately
  • 2.5 File and store securely all original documents, tapes, photographs and other material
  • 2.6 Prepare and communicate appropriate changes in brief or instructions
  • 2.7 Comply with any changes in brief or instructions
3. Report on investigation
  • 3.1 Prepare and transmit comprehensive reports according to reporting guidelines
  • 3.2 Provide copies of documents, tapes, photographs and other materials to insurer’s nominated person
  • 3.3 Give facts and justification for conclusions to insurer’s nominated person
  • 3.4 Make recommendations for action, with appropriate justifications, where required
No information
No information
Replaces
State Code National Code Title Type
D4244 FNSISV506A Investigate claims Unit of competency
Replaced By
State Code National Code Title Type
OCZ40 FNSISV536 Investigate insurance claims Unit of competency