Unit of competency Outline

Date retreived
24/07/2026 1:08 AM AWST

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Manage non-routine and complex insurance claims

Manage non-routine and complex insurance claims

Unit of competency
National Code
FNSISV520
State Code
OCI44
TGA Status
Current
DTWD Status
Approved
Current Release Number
1.00
Current Release Date
04/11/2020
View on TGA
State Implementation and Classification
Approved Date
11/03/2021
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
11/03/2021
Nominal Hours
35
Description
This unit describes the skills and knowledge required to manage non-routine and complex insurance claims. It includes non-standard issues, determining the business impact, and managing all aspects of the claims-resolution process.The unit applies to those who apply specialist knowledge and functions when managing non-routine and complex insurance claims, such as major losses, bodily injury losses, long-term settlement, and claims involving legal procedures across international boundaries.Work functions in the occupational areas where this unit may be used are subject to regulatory requirements. Users are advised to check with the relevant state and territory regulatory authorities to confirm those requirements.
Notes
Elements and Performance Criteria
1. Analyse claim to determine validity
  • 1.1 Validate claim information, check its accuracy and completeness, and assess it against organisational policies and procedures, policy acceptance criteria, and claims guidelines
  • 1.2 Manage sensitivities and protocols relating to privacy and confidentiality of information when handling investigations
  • 1.3 Identify suspicious, fraudulent and non-standard elements of claim
  • 1.4 Seek supporting advice from specialists, as required
  • 1.5 Notify reinsurer of any claim within required timeframes
2. Evaluate impact of claim
  • 2.1 Analyse data relating to extent of loss, damage or injury, and seek and review claim estimates
  • 2.2 Determine strategies to minimise negative impact of any non-routine or complex claim within policy obligations
  • 2.3 Determine necessity for urgent action to protect organisational interests
3. Determine settlement options
  • 3.1 Identify settlement options within policy obligations and according to organisational, legislative and regulatory requirements
  • 3.2 Seek advice on settlement options from appropriate stakeholders, as required
  • 3.3 Prepare statement of claims settlement as required
4. Manage support arrangements to resolve claim
  • 4.1 Liaise with required internal and external stakeholders to identify and meet support requirements
  • 4.2 Manage legal processes associated with claim as required
  • 4.3 Negotiate to resolve any issues or disputes associated with significant claim
5. Finalise claim process
  • 5.1 Recommend continuous improvements to policies and procedures to enhance outcome for insured and organisation
  • 5.2 Provide stakeholders with advice on claim proceedings
  • 5.3 Document claim characteristics, actions, procedures and outcomes according to legislative and organisational requirements
No information
No information
Replaces
State Code National Code Title Type
AUS21 FNSISV510 Manage non-routine and complex claims Unit of competency
State Code National Code Title Type
BFX4 FNS51120 Diploma of General Insurance Qualification