Unit of competency Outline

Date retreived
23/07/2026 4:29 PM AWST

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Analyse insurance claims

Analyse insurance claims

Unit of competency
National Code
FNSISV405
State Code
AUX01
TGA Status
Current
DTWD Status
Approved
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 analyse insurance claims including researching and validating the claim information, and maintaining records and lines of communication.It applies to individuals whose job roles involve client service, data processing or 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. Collect and organise information relating to claim
  • 1.1 Obtain all relevant information to determine whether valid claim exists
  • 1.2 Organise relevant information into coherent and valid body of case knowledge
  • 1.3 Maintain confidentiality of information according to legislative requirements and industry principles
  • 1.4 Identify any information deficiencies and seek additional information from appropriate sources
2. Research claim and validate claim information
  • 2.1 Check claims information to determine legitimacy of claim, including validity of policy and whether claimant is eligible to claim on policy
  • 2.2 Identify needs for investigation and/or further information and appoint appropriate service providers where necessary
  • 2.3 Undertake investigation and research within established claims management criteria and authorities
  • 2.4 Monitor progress of investigation, if applicable
  • 2.5 Refer all missing information, abnormalities or classification uncertainties to an appropriate authority
3. Maintain records and lines of communication
  • 3.1 Maintain regular contact with relevant parties to ensure they are aware of current status of claim and are actively participating in process
  • 3.2 Communicate information promptly to underwriter, which impacts on policy
  • 3.3 Maintain regular and accurate diary system, and adhere to timelines
No information
No information
Replaces
State Code National Code Title Type
D4237 FNSISV405A Analyse insurance claims Unit of competency