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|SOUTH AFRICAN QUALIFICATIONS AUTHORITY|
|Occupational Certificate: Insurance Claims Administrator (Insurance Claims Assessor)|
|SAQA QUAL ID||QUALIFICATION TITLE|
|99668||Occupational Certificate: Insurance Claims Administrator (Insurance Claims Assessor)|
|Development Quality Partner - INSETA|
|PRIMARY OR DELEGATED QUALITY ASSURANCE FUNCTIONARY||NQF SUB-FRAMEWORK|
|-||OQSF - Occupational Qualifications Sub-framework|
|Occupational Certificate||Field 03 - Business, Commerce and Management Studies||Finance, Economics and Accounting|
|ABET BAND||MINIMUM CREDITS||PRE-2009 NQF LEVEL||NQF LEVEL||QUAL CLASS|
|Undefined||131||Not Applicable||NQF Level 04||Regular-ELOAC|
|REGISTRATION STATUS||SAQA DECISION NUMBER||REGISTRATION START DATE||REGISTRATION END DATE|
|LAST DATE FOR ENROLMENT||LAST DATE FOR ACHIEVEMENT|
|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 qualification does not replace any other qualification and is not replaced by any other qualification.
|PURPOSE AND RATIONALE OF THE QUALIFICATION|
The purpose of this qualification is to prepare a learner to operate as an Insurance Claims Administrator (Insurance Claims Assessor). An Insurance Claims Administrator (Insurance Claims Assessor) assesses the validity of the claim against the contract in order to determine or recommend whether to settle or reject a claim and provide comments on risk improvements and moral risks.
A qualified learner will be able to:
According to the Insurance Sector Skills Plan (SSP), there are scarce skills identified within the industry. Whilst Insurance Claims Assessors were not explicitly named, it is one of the professional occupations in the sector where there is a scarcity of skills. This qualification is aimed at ensuring the development of qualified assessors to address this scarcity.
Wide consultation with professional bodies such as the Insurance Institute of South Africa (IISA) and the Financial Planning Institute (FPI) was undertaken by the Insurance Sector Education and Training Authority (INSETA) prior to the development of the qualification. As a result, this Insurance Claims Assessor's occupational qualification in Short-term, Long-term, Health and Statutory insurance sectors was proposed.
The qualification will provide knowledge and skills required by learners operating within the outlined sectors. It will also equip new entrants and those who are currently employed within the industry with knowledge and skills to competently function as Insurance Claims Assessors. Individuals operating in these sectors as Administrators, Claims Negotiators, Claims Officers and Insurance Claims Assessors will benefit from this qualification.
This qualification will benefit individuals who have worked competently as Insurance Claims Assessors without formal education since they will have the acquired skills and knowledge recognised through the process of Recognition of Prior Learning (RPL).
Qualified learners will have a competitive advantage to gain employment within the claims environment. The industry will benefit from the employment of qualified assessors who will perform their jobs effectively and thereby contribute efficiently to the economy.
|LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING|
|Recognition of Prior Learning (RPL):
RPL for access to the external integrated summative assessment: Accredited providers and approved workplaces must apply the internal assessment criteria specified in the related curriculum document to establish and confirm prior learning. Accredited providers and workplaces must confirm prior learning by issuing a statement of result or certifying a work experience record.
RPL for access to the qualification: Accredited providers and approved workplaces may recognise prior learning against the relevant access requirements.
NQF Level 4 qualification or 3 years work experience in the Insurance industry.
|RECOGNISE PREVIOUS LEARNING?|
|This qualification is made up of the following compulsory Knowledge and Practical Skill Modules:
Total number of credits for Knowledge Modules: 41.
Practical Skill Modules:
Total number of credits for Practical Skill Modules: 40.
This qualification also requires the following Work Experience Modules:
Total number of credits for Work Experience Modules is 50 credits per relevant insurance sector.
|EXIT LEVEL OUTCOMES|
|1. Identify, analyse and verify the validity of claims in the relevant insurance context.
2. Assess, calculate and complete claims in the relevant insurance context.
3. Finalise claims in the relevant insurance context.
|ASSOCIATED ASSESSMENT CRITERIA|
|Associated Assessment Criteria for Exit Level Outcome 1:
Associated Assessment Criteria for Exit Level Outcome 2:
Associated Assessment Criteria for Exit Level Outcome 3:
Integrated Formative Assessment:
The skills development provider will use the curriculum to guide them on the stipulated internal assessment criteria and weighting. They will also apply the scope of practical skills and applied knowledge as stipulated by the internal assessment criteria. This formative assessment leads to entrance into the integrated external summative assessment.
Integrated Summative Assessment:
An external integrated summative assessment, conducted through the relevant Quality Council for Trades and Occupations (QCTO) Assessment Quality Partner is required for the issuing of this qualification. The external integrated summative assessment will focus on the exit level outcomes and associated assessment criteria. The external assessment will be conducted by means of written assessments conducted by registered assessors at accredited assessment centres over a period of not more than 3 hours.
|A comprehensive international comparison between the South African Insurance Claims Administrator (Insurance Claims Assessor) occupational qualification and other Insurance Claims related qualifications offered in countries such as Australia, New Zealand and Canada respectively was undertaken. These countries were chosen due to the similarities between the qualifications.
A Certificate IV in General Insurance code FNS41411 offered in Australia was found to compare favourably to the Occupational Certificate: Insurance Claims Administrator (Insurance Claims Assessor). The Australian qualification is mainly designed for the Insurance Administrators and Claims Officers. The purpose of the qualification is to capacitate qualified officers so that they can handle claims, issue domestic insurance contracts, deal with customer enquiries, appoint intermediaries to investigate standard claims and initiate claims recovery.
Modules covered in the qualification include amongst others, the following:
The qualification is designed in such a way that it will take a maximum of 24 months (2 years) to complete.
There are no specific entry requirements specified.
It was found that New Zealand offers an Insurance Claims Officer qualification which specialises in general insurance. This generic qualification covers areas such as house and contents, commercial, motor vehicle and marine insurance; or life insurance, which includes health insurance, disability insurance and superannuation.
Upon completion the learner will be able to:
There are no specific entry requirements to become an Insurance Claims Officer.
Although the title of the qualification offered in Canada differs from the South African occupational qualification, the study has shown that the content of these qualifications compares favourably. The qualification offered is called Insurance Adjusters and Claims Examiners NOC 1312. It is divided into two groups: Insurance Adjusters and Claims Examiners. Insurance Adjusters investigate insurance claims and determine the amount of loss or damages covered by insurance policies. Insurance Claims Examiners examine claims investigated by Insurance Adjusters and authorise payments.
Insurance Adjusters perform some or all of the following duties:
The Insurance Claims Examiners, on the other hand, are expected to perform some or all of the following duties:
The similarities have been found in some of the tasks or duties to be performed by a qualified learner. In addition to this, entry requirements are also comparable to the Australian as well as the New Zealand qualifications. In both cases, learners are expected to have acquired at least three years of relevant experience to qualify for admission to learning as a substitute for the formal education.
In all qualifications offered in other countries, it was found that the purpose of the qualification is to perform and assess the damage and to minimise the cost of claims to an insurance company. This is similar to the purpose statement of the South African occupational qualification.
The main differences identified include, amongst others, the title of the occupation, duration and structure of the qualifications. The title of a South African qualified learner is 'Insurance Claims Administrator (Insurance Claims Assessor) whereas in New Zealand, a qualified learner is called 'Insurance Claims Officer and General Insurer'.
The New Zealand qualification has some tasks that are not covered in the South African occupational qualification. For an example, it has been noted that a qualified learner is expected to appoint Insurance Loss Adjusters and Private Investigators. This task is not included in the South African occupational qualification.
Based on the findings of the comparability study, it is concluded that the Occupational Certificate: Insurance Claims Administrator (Insurance Claims Assessor) compares favourably to other qualifications offered in some countries.
|This qualification articulates horizontally to:
This qualification articulates vertically to:
|CRITERIA FOR THE REGISTRATION OF ASSESSORS|
|Qualifying for External Assessment:
In order to qualify for the external summative assessment learners must have a copy of a completed and signed Statement of Work Experience as well as proof of successful completion of all knowledge and practical skill modules outlined in the curriculum including Foundational Learning Competence.
Additional legal or physical entry requirements:
No additional legal or physical entry requirements are required.
Criteria for the accreditation of providers
Accreditation of providers will be done against the criteria as reflected in the relevant curriculum on the Quality Council for Trades and Occupations (QCTO) website.
The curriculum title and code is: Insurance Claims Assessor and 431204001.
|LEARNING PROGRAMMES RECORDED AGAINST THIS QUALIFICATION:|
|PROVIDERS CURRENTLY ACCREDITED TO OFFER THIS QUALIFICATION:|
|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.||Felix Risk Training Consultants|
|2.||Kairos Training College|