Unit of competency
Modification History
Release |
Comments |
Release 1 |
This version first released with FNS Financial Services Training Package Version 1.0. |
Application
This unit describes the skills and knowledge required to effectively handle claims made against group life insurance policies.
It applies to those engaged in case management and claims management functions associated with group life insurance policies.
No licensing, legislative or certification requirements apply to this unit at the time of publication.
Unit Sector
Life insurance
Elements and Performance Criteria
ELEMENT |
PERFORMANCE CRITERIA |
Elements describe the essential outcomes. |
Performance criteria describe the performance needed to demonstrate achievement of the element. |
1. Receive claim against group life policy |
1.1 Check that correct channels of lodgement have been followed 1.2 Identify relevant policy and type of cover 1.3 Evaluate evidence of member’s identity |
2. Review member’s group history and eligibility for cover |
2.1 Identify whether cover was granted within policy’s automatic acceptance provisions or if it was individually underwritten 2.2 Establish whether member was at work on commencement date of present insurance 2.3 Verify that premium contributions are current and correct |
3. Manage relationships and information collection |
3.1 Identify important contact points and intermediaries, and confirm each one’s role and responsibilities 3.2 Identify communication channels most appropriate to each relationship 3.3 Manage information collection and communication strategy 3.4 Refer case to suitably authorised team member where communication problems arise, in accordance with organisational policy and procedures |
4. Assess claim |
4.1 Review claim submission to establish circumstances of member’s claimed condition 4.2 Identify appropriate policy wordings to establish assessment criteria 4.3 Evaluate evidence to determine whether assessment criteria are met 4.4 Assess whether client complied with all additional disclosure requirements where cover was provided by means other than automatic acceptance 4.5 Decide whether a benefit is payable 4.6 Consider opportunity for rehabilitation with disability claims |
5. Pay group life insurance benefits |
5.1 Determine entitlements as per relevant policy conditions, within authority levels and obtain sign-off where required 5.2 Identify parties authorised to receive benefits paid by insurer 5.3 Communicate decisions to relevant parties, in accordance with procedures and regulatory requirements 5.4 Evaluate dependent relationships and beneficiary nominations for death benefits, if necessary 5.5 Set in place ongoing assessment processes for salary continuance claims and ensure benefit is appropriately taxed prior to payment |
Foundation Skills
This section describes language, literacy, numeracy and employment skills incorporated in the performance criteria that are required for competent performance.
Skill |
Performance Criteria |
Description |
Reading |
1.1-1.3, 2.1-2.3, 3.1, 3.2, 4.1-4.4, 5.1, 5.2, 5.4 |
|
Writing |
5.1, 5.3 |
|
Oral Communication |
2.2, 3.4, 5.1, 5.3, 5.5 |
|
Numeracy |
5.1, 5.5 |
|
Navigate the world of work |
5.1, 5.3 |
|
Interact with others |
2.2, 3.1-3.4, 5.3 |
|
Get the work done |
1.1-1.3, 2.1-2.3, 3.1-3.4, 4.1-4.6, 5.1-5.5 |
|
Unit Mapping Information
Code and title current version |
Code and title previous version |
Comments |
Equivalence status |
FNSILF506 Manage group life insurance claims |
FNSILF506A Manage group life insurance claims |
Updated to meet Standards for Training Packages |
Equivalent unit |
Links
Companion Volume implementation guides are found in VETNet - https://vetnet.gov.au/Pages/TrainingDocs.aspx?q=c7200cc8-0566-4f04-b76f-e89fd6f102fe