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Unit of competency details

FNSISV506 - Investigate insurance claims (Release 1)

Summary

Usage recommendation:
Superseded
Mapping:
MappingNotesDate
Supersedes and is equivalent to FNSISV506A - Investigate claimsUpdated to meet Standards for Training Packages 24/Mar/2015
Is superseded by and equivalent to FNSISV536 - Investigate insurance claims 01/Feb/2021

Releases:
ReleaseRelease date
1 1 (this release) 25/Mar/2015


Classifications

SchemeCodeClassification value
ASCED Module/Unit of Competency Field of Education Identifier 081103 Insurance And Actuarial Studies  

Classification history

SchemeCodeClassification valueStart dateEnd date
ASCED Module/Unit of Competency Field of Education Identifier 081103 Insurance And Actuarial Studies  30/Jul/2015 
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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 investigate an insurance claim. Investigation may cover the degree of liability or a potential fraud and covers clarifying the brief, conducting the investigation and reporting on the findings.

It applies to individuals working in job roles involving specialist knowledge and functions including claims and 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.

Unit Sector

Insurance services

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. Clarify brief and instructions

1.1 Clarify brief provided to investigator including facts of claim, insurer’s instructions and outcomes required

1.2 Check subject matter questions to be investigated

2. Investigate claim

2.1 Determine method of investigation

2.2 Collect and organise required information to make logical case

2.3 Carry out investigations in accordance with legislation, regulations and organisational operating procedures and codes of practice, if applicable

2.4 Record all data and information progressively and accurately

2.5 File and store securely all original documents, tapes, photographs and other material

2.6 Prepare and communicate appropriate changes in brief or instructions

2.7 Comply with any changes in brief or instructions

3. Report on investigation

3.1 Prepare and transmit comprehensive reports according to reporting guidelines

3.2 Provide copies of documents, tapes, photographs and other materials to insurer’s nominated person

3.3 Give facts and justification for conclusions to insurer’s nominated person

3.4 Make recommendations for action, with appropriate justifications, where required

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, 1.2, 2.2

  • Critically analyses plans and other documentation from a variety of sources and consolidates information to determine requirements

Writing

1.1, 2.4, 2.6, 3.1, 3.3, 3.4

  • Accurately records conversations and other details, and transfers information into organisational systems
  • Writes, edits and proofreads documents and reports to ensure clarity of meaning, and accuracy and consistency of information

Oral Communication

1.1, 2.6, 3.3, 3.4

  • Interacts effectively in verbal exchanges, using active listening and questioning to convey and clarify information

Numeracy

2.2, 3.3

  • Performs mathematical calculations to interpret and compare financial data and information

Navigate the world of work

2.3, 3.1

  • Takes full responsibility for following policies, procedures and legislative requirements, and identifies organisational implications of new legislation or regulation

Interact with others

2.6, 3.3, 3.4

  • Selects and uses appropriate conventions and protocols when communicating with a diverse range of colleagues and clients to build rapport and foster strong relationships

Get the work done

1.1, 2.1, 2.3, 2.5, 2.7, 3.2, 3.3

  • Accepts responsibility for planning and sequencing complex tasks and workload, negotiating key aspects with others and taking into account capabilities, efficiencies and effectiveness
  • Responds intuitively to problems requiring immediate resolution, drawing on past experiences to focus on the cause of a problem
  • Uses digital technologies to access, enter and store information required to complete work tasks

Unit Mapping Information

Code and title 

current version 

Code and title 

previous version 

Comments 

Equivalence status 

FNSISV506 Investigate insurance claims

FNSISV506A Investigate 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

 

Assessment requirements

Modification History

Release 

Comments 

Release 1

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

Performance Evidence

Evidence of the ability to:

  • use appropriate investigation methodologies and maintain accurate records
  • comply with relevant legislation and regulatory requirements in investigating a claim
  • produce complete and accurate investigation reports
  • provide detailed scoping for investigating insurance claims including in-scope and out-of-scope areas
  • develop options to resolve issues or problems that have the potential to impact on work outcomes during investigations.

Note: If a specific volume or frequency is not stated, then evidence must be provided at least once

Knowledge Evidence

To complete the unit requirements safely and effectively, the individual must:

  • outline key requirements of industry sector legal obligations and organisational procedures in relation to investigating claims
  • describe and implement appropriate investigation methods including:
  • interviews
  • surveillance
  • internet research
  • document authentication
  • observation
  • identify key features of relevant legislation, regulatory guidelines and industry sector codes of practice as they apply to:
  • insurance contracts
  • consumer protection
  • privacy
  • insurance investigation
  • explain the importance of report writing conventions in insurance investigations.

Assessment Conditions

Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance services field of work and include access to:

  • organisational records
  • organisational policy, procedures, legislation and regulations as they relate to contracts of insurance
  • a range of common technology and software.

Assessors must satisfy NVR/AQTF assessor requirements.

Links

Companion Volume implementation guides are found in VETNet - https://vetnet.gov.au/Pages/TrainingDocs.aspx?q=c7200cc8-0566-4f04-b76f-e89fd6f102fe