Release 

Comments 

Release 1

This version first released with FNS Financial Services Training Package Version 1.0.

ELEMENT 

PERFORMANCE CRITERIA 

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Confirm validity of claim

1.1 Receive and acknowledge claim notification

1.2 Review details of life insurance policy to ensure valid cover is in force

1.3 Establish that claimant is authorised to deal with policy

1.4 Compile necessary documentation

1.5 Check that documentation is correct and complete, and address any gaps in accordance with procedures

1.6 Assess organisational authority level required to process claim and refer it to an appropriately authorised individual as necessary

2. Conduct complex claim assessment

2.1 Review and apply policy terms, conditions and definitions to identify payment criteria in accordance with procedures

2.2 Identify and review evidence against payment criteria in accordance with procedures

2.3 Review all information relevant to circumstances of loss, damage or injury to establish chain of events

2.4 Identify potential fraud indicators

2.5 Identify whether policy exclusions apply

2.6 Recognise need for further information and collect as appropriate

3. Appoint specialists to assist in complex claims assessment as required

3.1 Identify need to appoint specialists to undertake claims assessment

3.2 Engage and brief appointed specialists as required

3.3 Monitor specialists’ activities to ensure adherence to timelines, procedures and ethical and regulatory requirements

3.4 Interpret and utilise specialists' reports

4. Assess and report on liability

4.1 Identify whether terms and conditions of policy have been verifiably met

4.2 Assess liability in accordance with terms and conditions of policy

4.3 Where claim is not admitted, communicate decision to appropriate stakeholders

4.4 Where claim is admitted, calculate payments due

5. Finalise claim payments

5.1 Advise client of consequences of proceeding with payment

5.2 Obtain policy discharge, as appropriate

5.3 Process payment in accordance with organisational authority levels, procedures and ethical and regulatory requirements

5.4 Update all appropriate records in accordance with procedures

5.5 Communicate settlement details to appropriate stakeholders in accordance with procedures and regulatory requirements

5.6 Initiate reinsurance recovery, if appropriate

Skill 

Performance Criteria 

Description 

Reading

1.1, 1.2, 1.5, 1.6, 2.1-2.6, 3.1, 3.3, 3.4, 4.1, 4.2

• Gathers, analyses and interprets simple to complex information from a range of sources to identify and consolidate information relevant to requirements

Writing

1.1, 1.4, 2.6, 3.2, 4.3, 5.1, 5.2, 5.4-5.6

• Produces, edits and proofreads documents to ensure clarity of meaning, and accuracy and consistency of information
• Accurately records and completes organisational documents using clear language and correct spelling, grammar and terminology

Oral Communication

1.3, 1.5, 1.6, 2.6, 3.2, 3.3, 4.3, 5.1, 5.5, 5.6

• Uses active listening and questioning techniques to convey and clarify information
• Clearly explains and shares information using language and tone appropriate to the audience and purpose

Numeracy

4.4

• Uses mathematical equations to perform calculations

Navigate the world of work

1.5, 1.6, 2.1, 2.2, 3.3, 5.3-5.5

• Takes full responsibility for adherence to legislative and ethical requirements, explicit and implicit protocols, policies and procedures, and meets expectations associated with own role

Interact with others

1.6, 3.2, 4.3, 5.1, 5.2, 5.5

• Selects and uses appropriate conventions and protocols when conferring with various stakeholders to gather or share information
• Adjusts personal communication style in response to the values, beliefs and cultural expectations of others

Get the work done

1.1-1.6, 2.1-2.6, 3.1-3.3, 4.2, 5.3-5.6

• Takes responsibility for planning, sequencing and prioritising tasks and own workload for efficiency and effectiveness
• Makes decisions regarding claim validity based on systematic analysis of all information, taking into account organisational requirements and the regulatory environment
• Uses the main features and functions of digital tools to complete work tasks

Code and title 

current version 

Code and title 

previous version 

Comments 

Equivalence status 

FNSILF504 Manage complex life insurance claims

FNSILF504A Manage complex life insurance claims

Updated to meet Standards for Training Packages

Equivalent unit

Release 

Comments 

Release 1

This version first released with FNS Financial Services Training Package Version 1.0.