Release 

Comments 

Release 1

This version first released with FNS Financial Services Training Package Version 7.0.

Supersedes and is not equivalent to FNSILF504 Manage complex life insurance claims.

Minor changes to application, elements and foundation skills. Significant rewording of performance criteria. Performance evidence and knowledge evidence updated to clarify intent.

ELEMENT 

PERFORMANCE CRITERIA 

Elements describe the essential outcomes.

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

1. Identify complexity of life insurance claim

1.1 Review details of life insurance policy and determine complexity of claim according to organisational policies and procedures

1.2 Document complexity of claim according to organisational policies and procedures

2. Conduct complex claim assessment

2.1 Identify, review and apply policy terms, conditions and exclusions to claim according to organisational policies and procedures

2.2 Analyse and document required information and evidence relevant to claim according to organisational policies and procedures

2.3 Determine eligibility of claim according to policy terms and conditions

2.4 Identify and analyse complex components of claim and document rationale for complexity

2.5 Document additional factors and rationale for complexity of claim where required

2.6 Document the need for further information and collect within required timeframes

3. Consult specialists regarding complex claims as required

3.1 Identify need to appoint specialists to undertake claims assessment

3.2 Engage and instruct appointed specialists as required

3.3 Monitor specialist activities as required

3.4 Document advice and information obtained from specialists and record subsequent actions required for completion of claims assessment

3.5 Instruct specialists to address complexities according to codes of ethics and professional practice, and legislative and regulatory requirements

4. Assess and report on liability

4.1 Review and analyse specialist information as required and determine if complexities have been addressed

4.2 Determine liability according to information obtained from specialist as required

4.3 Prepare recommendation and seek additional specialist advice where required

4.4 Document rationale and communicate decision to required stakeholders

4.5 Provide additional information as required and explain dispute process where a claim is not admitted

5. Finalise claim payments

5.1 Determine authority level required to evaluate claim and review the decision as required

5.2 Calculate and process payment according to organisational authority levels for approval, policies and procedures, code of ethics, and legislative and regulatory requirements, as required

5.3 Communicate outcomes to required stakeholders

5.4 Update policy and claim records and file documentation as required

5.5 Communicate settlement details to required stakeholders according to organisational policies and procedures, and legislative and regulatory requirements

5.6 Initiate reinsurance recovery as required

6. Finalise and close claim

6.1 File required documentation on claim according to organisational policies and procedures

6.2 Complete required medical, financial and closure fields in claims system according to organisational policies and procedures

6.3 Update policy records in required systems according to organisational policies and procedures

6.4 Close claim in required system and communicate closure to policy owner or authorised parties

Skill 

Description 

Numeracy

• Uses mathematical equations to perform calculations

Oral communication

• Uses active listening and questioning techniques to convey and clarify information
• Explains and shares information with various stakeholders using language, tone, conventions and protocols required for audience and purpose

Reading

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

Writing

• Produces routine texts using structure, grammar and vocabulary appropriate to task and context
• Edits and proofreads documents to ensure clarity of meaning, and accuracy and consistency of information

Planning and organising

• 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 regulatory environment

Self-management

• Follows legislative requirements; codes of ethics and professional practice; and protocols, policies and procedures

Technology

• Uses key features and functions of digital tools to complete work tasks

Release 

Comments 

Release 1

This version first released with FNS Financial Services Training Package Version 7.0.

Supersedes and is not equivalent to FNSILF504 Manage complex life insurance claims.

Minor changes to application, elements and foundation skills. Significant rewording of performance criteria. Performance evidence and knowledge evidence updated to clarify intent.