SAQA All qualifications and part qualifications registered on the National Qualifications Framework are public property. Thus the only payment that can be made for them is for service and reproduction. It is illegal to sell this material for profit. If the material is reproduced or quoted, the South African Qualifications Authority (SAQA) should be acknowledged as the source.
SOUTH AFRICAN QUALIFICATIONS AUTHORITY 
REGISTERED UNIT STANDARD: 

Apply technical knowledge and insight to process a complex claim in Long-Term insurance 
SAQA US ID UNIT STANDARD TITLE
120061  Apply technical knowledge and insight to process a complex claim in Long-Term insurance 
ORIGINATOR
SGB Insurance and Investment 
PRIMARY OR DELEGATED QUALITY ASSURANCE FUNCTIONARY
-  
FIELD SUBFIELD
Field 03 - Business, Commerce and Management Studies Finance, Economics and Accounting 
ABET BAND UNIT STANDARD TYPE PRE-2009 NQF LEVEL NQF LEVEL CREDITS
Undefined  Regular  Level 5  Level TBA: Pre-2009 was L5 
REGISTRATION STATUS REGISTRATION START DATE REGISTRATION END DATE SAQA DECISION NUMBER
Reregistered  2018-07-01  2023-06-30  SAQA 06120/18 
LAST DATE FOR ENROLMENT LAST DATE FOR ACHIEVEMENT
2024-06-30   2027-06-30  

In all of the tables in this document, both the pre-2009 NQF Level and the NQF Level is shown. In the text (purpose statements, qualification rules, etc), any references to NQF Levels are to the pre-2009 levels unless specifically stated otherwise.  

This unit standard does not replace any other unit standard and is not replaced by any other unit standard. 

PURPOSE OF THE UNIT STANDARD 
This Unit Standard is intended Senior Claims Assessors and Reinsurers and learners in Actuarial learnerships in Long-Term insurance.

The qualifying learner is capable of:
  • Substantiating a request for additional information.
  • Analysing all aspects required to assess the validity of a complex claim.
  • Synthesising the relevant aspects of a claim.
  • Making and substantiating a decision about a complex claim. 

  • LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
    Learners should be competent in Communication and Mathematical Literacy at Level 4. It is assumed that learners are competent in the Unit Standards in the FETC: Long-Term Risk Assessment. 

    UNIT STANDARD RANGE 
    The typical scope of this Unit Standard is disability claims against Long-Term insurance policies. 

    Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Substantiate a request for additional information. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Reports and additional information appropriate to a specific claim are identified and the request is justified in terms of value added and cost. 

    ASSESSMENT CRITERION 2 
    Questions are asked to obtain collateral information. 

    ASSESSMENT CRITERION 3 
    The consequences of delaying a decision are identified with reference to contractual stipulations and service level agreements. 

    SPECIFIC OUTCOME 2 
    Analyse all aspects required to assess the validity of a claim. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Relevant clauses in a policy document are applied to a specific claim. 

    ASSESSMENT CRITERION 2 
    Legal and contractual aspects of the claim are investigated to determine the validity of a claim. 

    ASSESSMENT CRITERION 3 
    Medical information is analysed to determine the validity of a claim. 

    SPECIFIC OUTCOME 3 
    Synthesise relevant aspects of a claim. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Information on a claim is analysed, interpreted and synthesised to obtain a holistic picture. 

    ASSESSMENT CRITERION 2 
    Information relating to a claim is discussed in an appropriate forum according to an organisation's policy. 

    SPECIFIC OUTCOME 4 
    Make and substantiate a decision about a complex claim. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    A decision is made and substantiated to admit, decline or defer a claim. 

    ASSESSMENT CRITERION 2 
    A claim decision is communicated to the relevant parties. 

    ASSESSMENT CRITERION 3 
    A proposal is made for the management of a deferred or admitted claim. 


    UNIT STANDARD ACCREDITATION AND MODERATION OPTIONS 
    This Unit Standard will be internally assessed by the provider and moderated by a moderator registered by a relevant accredited ETQA or an ETQA that has a Memorandum of Understanding with the relevant accredited ETQA. 

    UNIT STANDARD ESSENTIAL EMBEDDED KNOWLEDGE 
    N/A 

    UNIT STANDARD DEVELOPMENTAL OUTCOME 
    N/A 

    UNIT STANDARD LINKAGES 
    N/A 


    Critical Cross-field Outcomes (CCFO): 

    UNIT STANDARD CCFO IDENTIFYING 
    The learner is able to identify and solve problems in which responses show that responsible decisions using critical and creative thinking have been made in assessing a complex claim. 

    UNIT STANDARD CCFO WORKING 
    The learner is able to work effectively with others as a member of a team, group or organisation in participating in forums to discuss complex claims. 

    UNIT STANDARD CCFO COLLECTING 
    The learner is able to collect, organise and critically evaluate information in preparing requesting additional information and analysing a complex claim. 

    UNIT STANDARD CCFO COMMUNICATING 
    The learner is able to communicate effectively in communicating a decision about a claim and discussing the claim in an appropriate forum. 

    UNIT STANDARD ASSESSOR CRITERIA 
    N/A 

    REREGISTRATION HISTORY 
    As per the SAQA Board decision/s at that time, this unit standard was Reregistered in 2012; 2015. 

    UNIT STANDARD NOTES 
    N/A 

    QUALIFICATIONS UTILISING THIS UNIT STANDARD: 
      ID QUALIFICATION TITLE PRE-2009 NQF LEVEL NQF LEVEL STATUS END DATE PRIMARY OR DELEGATED QA FUNCTIONARY
    Elective  49860   National Diploma: Financial Services: Long-Term Risk Assessment  Level 5  NQF Level 05  Reregistered  2023-06-30  INSETA 


    PROVIDERS CURRENTLY ACCREDITED TO OFFER THIS UNIT STANDARD: 
    This information shows the current accreditations (i.e. those not past their accreditation end dates), and is the most complete record available to SAQA as of today. Some Primary or Delegated Quality Assurance Functionaries have a lag in their recording systems for provider accreditation, in turn leading to a lag in notifying SAQA of all the providers that they have accredited to offer qualifications and unit standards, as well as any extensions to accreditation end dates. The relevant Primary or Delegated Quality Assurance Functionary should be notified if a record appears to be missing from here.
     
    1. CKP Development Agency (Pty) Ltd. 



    All qualifications and part qualifications registered on the National Qualifications Framework are public property. Thus the only payment that can be made for them is for service and reproduction. It is illegal to sell this material for profit. If the material is reproduced or quoted, the South African Qualifications Authority (SAQA) should be acknowledged as the source.