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14 Claim Examiner Interview Questions (With Example Answers)

It's important to prepare for an interview in order to improve your chances of getting the job. Researching questions beforehand can help you give better answers during the interview. Most interviews will include questions about your personality, qualifications, experience and how well you would fit the job. In this article, we review examples of various claim examiner interview questions and sample answers to some of the most common questions.

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Common Claim Examiner Interview Questions

How do you prioritize and manage competing demands on your time?

An interviewer would ask "How do you prioritize and manage competing demands on your time?" to a/an Claim Examiner in order to gauge the Claim Examiner's time management skills. Time management is important for Claim Examiners because they often have to juggle multiple claims at the same time.

Example: “There are a few ways that I prioritize and manage competing demands on my time. The first way is to use a prioritization matrix. This helps me to quickly see which tasks are the most important and need to be completed first. I also keep a daily to-do list and schedule out my day so that I can make sure I am getting everything done that needs to be done. Finally, I make sure to communicate with others about what my priorities are and ask for help when needed so that I can stay on track.”

What is your experience with the insurance claims process?

The interviewer is asking about the Claim Examiner's experience with the insurance claims process because it is important to know how knowledgeable the Claim Examiner is about the process. The insurance claims process can be complicated, and it is important to have someone who is familiar with it. The interviewer wants to know if the Claim Examiner has the necessary experience to be able to handle the claims process.

Example: “I have worked as a claim examiner for over 5 years. I have experience with all aspects of the insurance claims process, from initial intake through to final settlement. I have a strong working knowledge of the relevant laws and regulations, and am well-versed in the claims process itself. I am able to effectively manage a caseload and work efficiently to resolve claims in a timely manner.”

How do you handle difficult or challenging customer inquiries or requests?

The interviewer is trying to gauge the Claim Examiner's customer service skills. It is important because the Claim Examiner will be responsible for dealing with customers who are experiencing problems with their claims. The Claim Examiner needs to be able to handle difficult inquiries and requests in a professional and efficient manner.

Example: “There are a few ways to handle difficult or challenging customer inquiries or requests. The first is to try and understand the customer's needs and what they are looking for. Sometimes, customers may not be entirely sure what they need, and it can be helpful to ask clarifying questions. Once you have a good understanding of the customer's needs, you can then start to look for solutions that will meet those needs. If there are multiple possible solutions, you can present the options to the customer and let them choose which one they prefer. Finally, it is important to keep the lines of communication open with the customer throughout the process so that they feel informed and updated on the status of their request.”

Tell me about a time when you had to negotiate or persuade someone to see your point of view.

This question is important because it allows the interviewer to gauge the Claim Examiner's ability to negotiate and persuade others. This is a key skill for Claim Examiners, as they often need to convince insurance companies to pay out on claims. By understanding how the Claim Examiner has handled similar situations in the past, the interviewer can get a better sense of their ability to do so in the future.

Example: “I was working as a claims examiner for an insurance company and I had to negotiate with claimants on a regular basis. In one particular instance, I was dealing with a claimant who was very upset and adamant about getting a higher payout than we were offering. I explained our position to the claimant and tried to persuade them to accept the offer, but they were not budging.

I ended up having to do some research and digging to find out what similar cases had been settled for, and used that information to try and come to an agreement. In the end, we were able to reach a compromise that both parties were happy with.”

Can you give me an example of a time when you had to deal with a difficult customer or client?

There are a few reasons why an interviewer might ask this question to a claim examiner. First, it can help them gauge the level of customer service skills the claim examiner has. Second, it can give the interviewer insight into how the claim examiner handles difficult situations. Finally, it can help the interviewer determine if the claim examiner is a good fit for the company.

Example: “I had a situation where a customer was extremely upset about the outcome of their claim. They were yelling and screaming and demanding to speak to a supervisor. I remained calm and professional and explained the situation to them. I then offered to escalate their call to a supervisor. The customer calmed down and agreed to speak with the supervisor.”

Tell me about a time when you had to handle a complex or challenging claim.

Some possible reasons an interviewer might ask a claim examiner about a time when they had to handle a complex or challenging claim include:

-To assess the claim examiner's ability to handle complex claims

-To assess the claim examiner's problem solving skills

-To assess the claim examiner's knowledge of the claims process

-To assess the claim examiner's customer service skills

It is important for a claim examiner to be able to handle complex and challenging claims because they are likely to encounter them during their career. Claim examiners need to have strong problem solving skills in order to be able to resolve complex claims. They also need to have a good understanding of the claims process and be able to provide excellent customer service.

Example: “I had to handle a complex or challenging claim a few years ago when I was working as a claim examiner for an insurance company. The claim involved a car accident where the other driver was at fault. However, the other driver did not have insurance and the policyholder did not have uninsured motorist coverage.

The policyholder had to be hospitalized for his injuries and incurred significant medical bills. He also missed several weeks of work, resulting in lost wages. We were able to work with the policyholder and his attorney to negotiate a settlement that covered all of his damages and was fair to both parties.”

What is your experience with the appeals process for insurance claims?

An interviewer would ask "What is your experience with the appeals process for insurance claims?" to a/an Claim Examiner in order to gauge the Claim Examiner's familiarity with the process and to see if they have any relevant experience. The appeals process for insurance claims is important because it allows claimants to challenge the denial of their claims and potentially receive the benefits they are entitled to.

Example: “I have extensive experience with the appeals process for insurance claims. I have worked with many different insurance companies and have a good understanding of the process. I have also worked with many different types of appeals, including medical, dental, and vision appeals. I have a good understanding of the different types of appeals and how to handle them.”

Have you ever had to deal with a denied claim? If so, how did you handle it?

There are a few reasons why an interviewer might ask this question to a claim examiner. First, it can help the interviewer understand the claimant's experience with the claims process. Second, it can give the interviewer insight into how the claimant handles adversity. Finally, it can help the interviewer assess the claimant's ability to communicate with insurance companies.

Example: “I have had to deal with denied claims in the past. I usually start by contacting the insurance company to find out why the claim was denied. I then work with the patient to gather any additional information or documentation that may be needed to appeal the decision. If necessary, I also contact the provider to get their side of the story and to see if they can provide any additional information. Once I have all of the information, I submit an appeal to the insurance company.”

What is your experience with the investigation process for insurance claims?

An interviewer would ask "What is your experience with the investigation process for insurance claims?" to a Claim Examiner to gain an understanding of the Claim Examiner's knowledge and expertise in conducting investigations into insurance claims. This is important because the interviewer wants to know if the Claim Examiner is qualified to handle the insurance claims investigation process and if they are familiar with the procedures involved.

Example: “I have worked as a claim examiner for over 5 years. In that time, I have gained a great deal of experience in investigating insurance claims. I am very familiar with the process of conducting an investigation, from start to finish. I know how to gather information, interview witnesses, and review evidence. I am also experienced in writing reports and making recommendations based on my findings.”

Tell me about a time when you had to investigate a suspicious claim.

There are many reasons why an interviewer might ask this question to a claim examiner. It could be to gauge the examiner's experience in investigating claims, to see how the examiner goes about investigating claims, or to get a sense of the examiner's analytical skills. It is important for the interviewer to ask this question because it will help to determine if the examiner is qualified for the position.

Example: “I was working as a claim examiner for an insurance company when I received a claim that seemed suspicious. The claimant said that their car had been damaged in an accident, but the damage didn't seem to match up with what they said had happened. I decided to investigate further by looking at the police report and talking to witnesses. I was able to determine that the claimant was lying about what had happened and denied their claim.”

Tell me about a time when you had to deal with a fraudulent claim.

There are a few reasons an interviewer might ask this question to a claim examiner. One reason is to see how the claim examiner would handle a difficult situation. Another reason is to see if the claim examiner has any experience with fraud claims. This question is important because it can help the interviewer understand the claim examiner's ability to handle difficult situations and to identify potential fraud.

Example: “I had to deal with a fraudulent claim about two years ago. The claimant said that they had been injured in a car accident and needed to be compensated for their medical bills and lost wages. However, after investigating the claim, I found that the claimant had not been in a car accident and had actually been injured at work. The claimant had filed a false claim in order to receive compensation they were not entitled to. I denied the claim and the claimant appealed the decision. However, after reviewing the evidence, the appeal was denied and the claimant was ordered to pay back any benefits they had received.”

Can you tell me about a time when you had to deal with an angry or upset customer?

There are a few reasons why an interviewer would ask this question to a claim examiner. One reason is to see if the claim examiner has the ability to stay calm in difficult situations. It is important for claim examiners to be able to stay calm when dealing with angry or upset customers because they need to be able to think clearly and make decisions quickly. Another reason why an interviewer would ask this question is to see if the claim examiner has the ability to diffusing difficult situations. It is important for claim examiners to be able to diffusing difficult situations because they need to be able to prevent the situation from escalating and getting out of control.

Example: “I had to deal with an angry or upset customer when I was working as a claim examiner. The customer was angry because their claim was denied. I explained to the customer that their claim was denied because it did not meet the criteria for coverage. I also offered to help the customer file a new claim. The customer was still upset, but they thanked me for my help.”

What do you do if you suspect that a claim may be fraudulent?

There are a few reasons an interviewer might ask this question to a claim examiner. The first reason is to gauge the claimant's knowledge of fraud and how to handle it. The second reason is to see if the claimant is able to identify potential fraud and take appropriate action. The third reason is to determine if the claimant is familiar with the company's procedures for handling fraud.

It is important for the interviewer to ask this question because it allows them to get a better understanding of the claimant's ability to handle fraud. Additionally, it allows the interviewer to gauge the claimant's understanding of the company's procedures for handling fraud.

Example: “If you suspect that a claim may be fraudulent, you should take the following steps:

1. Notify your supervisor or the claims fraud hotline.
2. Gather any evidence or information that supports your suspicion.
3. Cooperate with any investigation into the matter.”

There are a few reasons why an interviewer would ask this question to a claim examiner. First, the interviewer wants to know if the claim examiner has any direct experience with the legal process for insurance claims. This is important because it will help the interviewer to understand how well the claim examiner understands the legal process and whether they will be able to effectively handle any legal issues that may arise during the claims process. Second, the interviewer wants to know if the claim examiner has any indirect experience with the legal process for insurance claims. This is important because it will help the interviewer to understand how well the claim examiner understands the legal process and whether they will be able to effectively communicate with lawyers or other professionals who may be involved in the claims process. Finally, the interviewer wants to know if the claim examiner has any general knowledge of the legal process for insurance claims. This is important because it will help the interviewer to understand how well the claim examiner understands the legal process and whether they will be able to effectively navigate the legal system if necessary.

Example: “I have worked as a claim examiner for an insurance company for over 5 years. I have experience with the legal process for insurance claims, including reviewing and evaluating claim documents, negotiating settlements, and preparing cases for trial. I am familiar with the relevant laws and regulations, and have a good working relationship with the attorneys who handle our company's claims.”

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