14 Claims 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 claims examiner interview questions and sample answers to some of the most common questions.
Common Claims Examiner Interview Questions
- What does a typical day involve for a claims examiner?
- What is the most challenging part of the job?
- What skills are necessary to be successful in this role?
- What education and experience are required?
- What are the most common claims that you see?
- How do you determine whether a claim is valid?
- What are some red flags that indicate a fraudulent claim?
- How do you handle difficult claimants?
- How do you stay up-to-date on changes in the industry?
- What are some tips for streamlining the claims process?
- How can technology be used to improve claims management?
- What are some best practices for claims handling?
- How can claims departments improve customer satisfaction?
- What are some common mistakes that claims examiners make?
What does a typical day involve for a claims examiner?
The interviewer is trying to gauge the level of responsibility and stress that the claims examiner faces on a daily basis. This is important because it can help the interviewer determine if the claims examiner is able to handle the demands of the job and if they would be a good fit for the position.
Example: “A typical day for a claims examiner may involve reviewing and processing insurance claims. This may include reviewing documentation to determine if the claim is valid, contacting patients or providers to obtain additional information, and making decisions on whether to approve or deny claims. The claims examiner may also be responsible for investigating fraud or abuse cases, and providing customer service to claimants.”
What is the most challenging part of the job?
The interviewer is trying to gauge the applicant's understanding of the Claims Examiner role and what it entails. It is important to know what the most challenging part of the job is so that the applicant can be prepared for it and know what to expect.
Example: “The most challenging part of the job is to keep up with the ever-changing insurance industry and regulations.”
What skills are necessary to be successful in this role?
The interviewer is trying to gauge whether the Claims Examiner has the necessary skills to be successful in the role. It is important to know whether the Claims Examiner has the necessary skills to be successful in the role because it will help determine whether they are qualified for the position.
Example: “In order to be successful as a claims examiner, excellent analytical and research skills are necessary in order to properly review and assess claims. Additionally, strong communication skills are important in order to clearly communicate findings and recommendations to clients and colleagues. Finally, claims examiners must be highly organized and detail-oriented in order to keep track of large volumes of data and information.”
What education and experience are required?
An interviewer would ask "What education and experience are required?" to a/an Claims Examiner to determine if the candidate has the necessary qualifications for the position. It is important to know if the candidate has the required education and experience because it will help to ensure that the candidate is able to perform the job duties.
Example: “There is no one-size-fits-all answer to this question, as the education and experience requirements for claims examiners can vary depending on the specific position and company. However, most claims examiner positions will require at least a bachelor's degree in a relevant field such as insurance, business, or accounting. Additionally, many companies prefer candidates with previous experience working in an insurance claims department or a related field.”
What are the most common claims that you see?
There are a few reasons why an interviewer might ask this question to a claims examiner. First, it allows the interviewer to get a sense of the types of claims that the examiner is most familiar with. This can help the interviewer to gauge the examiner's experience and knowledge. Additionally, it can help the interviewer to identify any potential areas of concern that the examiner may have. For example, if the examiner is seeing a lot of claims for a particular type of injury, the interviewer may want to ask follow-up questions about how those claims are being handled. Finally, this question can also help the interviewer to understand the examiner's workload and how they are prioritizing their time.
Example: “There are a few different types of claims that we see on a regular basis. The most common are auto insurance claims, homeowner's insurance claims, and workers' compensation claims.”
How do you determine whether a claim is valid?
The interviewer is trying to determine whether the claims examiner is able to assess the validity of a claim. This is important because it allows the interviewer to gauge the claims examiner's ability to determine whether a claim is legitimate and whether they will be able to properly assess the validity of future claims.
Example: “There are a few key factors that claims examiners use to determine whether a claim is valid. First, they will review the policyholder's policy to see if the claim is covered under the terms of the policy. If it is not, the claim will likely be denied. Second, they will look at the circumstances surrounding the loss to see if it is something that would be covered by the policy. For example, if a policyholder files a claim for water damage and the examiner finds that the damage was caused by a leaking pipe that the policyholder knew about but did not repair, the claim may be denied. Finally, claims examiners will often consult with experts in various fields to get their opinion on whether a loss is covered by a policy.”
What are some red flags that indicate a fraudulent claim?
There are a few reasons why an interviewer might ask this question to a claims examiner. First, it is important for a claims examiner to be able to identify red flags that may indicate fraud. This is important because fraud can cost the insurance company a lot of money. Second, the interviewer may be trying to determine if the claims examiner is familiar with the types of fraud that are common in the insurance industry. This is important because it shows that the claims examiner is knowledgeable about the industry and is able to identify potential red flags.
Example: “There are a few red flags that may indicate a fraudulent claim:
1. The claim is for an unusually high amount of money.
2. The claim is for an item or service that is not typically covered by insurance.
3. The policyholder has a history of filing fraudulent claims.
4. The claim includes inconsistencies or information that does not add up.
5. The claimant is uncooperative or evasive when asked for additional information or documentation.”
How do you handle difficult claimants?
There are a few reasons why an interviewer would ask this question to a claims examiner. First, it allows the interviewer to gauge the claims examiner's ability to handle difficult claimants. Second, it allows the interviewer to see how the claims examiner would handle a difficult situation. Finally, it allows the interviewer to get a sense of the claims examiner's personality.
Example: “There are a few ways to handle difficult claimants. The first step is to try and understand their position and what they are looking for. Once you have a clear understanding of their position, you can start to work on a resolution. If the claimant is not cooperative, you may need to escalate the issue to a supervisor or manager.”
How do you stay up-to-date on changes in the industry?
There are a few reasons why an interviewer would ask "How do you stay up-to-date on changes in the industry?" to a claims examiner. First, it is important for claims examiners to be aware of changes in the industry so that they can properly adjudicate claims. Second, claims examiners need to be up-to-date on changes in the industry in order to provide accurate and up-to-date information to policyholders. Finally, being up-to-date on changes in the industry allows claims examiners to better protect the interests of the insurance company.
Example: “There are a few different ways that I stay up-to-date on changes in the industry. I read industry-specific news sources, attend relevant conferences, and keep in touch with my network of industry contacts. By staying informed, I am able to identify new trends and changes that could impact my work as a claims examiner.”
What are some tips for streamlining the claims process?
There are a few reasons why an interviewer might ask this question to a claims examiner. First, the interviewer may be interested in understanding how the claims examiner would streamline the claims process in order to make it more efficient. Second, the interviewer may be interested in understanding how the claims examiner would streamline the claims process in order to reduce the amount of time it takes to process claims. Finally, the interviewer may be interested in understanding how the claims examiner would streamline the claims process in order to reduce the number of errors that are made during the claims process.
Example: “There are a few things you can do to streamline the claims process:
1. Keep accurate and up-to-date records. This includes maintaining accurate contact information for both patients and providers, as well as keeping track of important dates and deadlines.
2. Stay organized. Develop a system for tracking claims so that you can easily access any information you need. This may include using a software program or creating a physical filing system.
3. Be efficient in your communications. When contacting patients or providers, have all of the relevant information ready so that you can quickly resolve any issues.
4. Follow up regularly. Check in with patients and providers to make sure that everything is progressing smoothly and that there are no outstanding issues.”
How can technology be used to improve claims management?
There are a few reasons why an interviewer might ask this question to a claims examiner. First, they may be trying to gauge the examiner's understanding of how technology can be used in claims management. Second, they may be interested in how the examiner would use technology to improve claims management in their own work. Finally, they may be trying to assess the examiner's ability to think critically about how technology can be used to improve claims management more broadly.
It is important for claims examiners to have a strong understanding of how technology can be used to improve claims management because technology can play a big role in streamlining the claims process and making it more efficient. Additionally, technology can help claims examiners to better document and track claims, which can improve accuracy and reduce errors.
Example: “Technology can be used to improve claims management in a number of ways. For example, it can be used to automate the claims process, making it faster and more efficient. It can also be used to improve communication between claimants and insurers, making it easier to resolve disputes. Additionally, technology can be used to provide data analytics that can help identify trends and improve the overall claims process.”
What are some best practices for claims handling?
There are a few reasons why an interviewer might ask a claims examiner about best practices for claims handling. First, the interviewer wants to see if the claims examiner is familiar with the topic. Second, the interviewer wants to see if the claims examiner can provide specific examples of best practices. Finally, the interviewer wants to see if the claims examiner understands why it is important to follow best practices for claims handling.
Some best practices for claims handling include staying organized, keeping detailed records, and communicating regularly with all parties involved in the claim. It is important to follow these practices because they help to ensure that the claim is processed efficiently and correctly.
Example: “There are a number of best practices for claims handling, which include:
1. Establishing and maintaining clear communication with the insured/claimant.
2. Thoroughly investigating the claim and all available information.
3. Determining coverage based on the facts of the claim and policy provisions.
4. Promptly resolving claims where possible, and keeping the insured/claimant updated on status and progress.
5. Fairly and equitably settling valid claims in a timely manner.”
How can claims departments improve customer satisfaction?
There are a few reasons why an interviewer might ask this question to a claims examiner. First, customer satisfaction is an important metric for any business, and claims departments are no exception. Second, claims departments are often the first point of contact for customers after they have had an accident or other incident, so it is important for claims examiners to be able to provide good customer service. Finally, claims departments can always improve their customer satisfaction levels, so this question allows the interviewer to gauge the examiner's thoughts on the matter.
Example: “There are a number of ways in which claims departments can improve customer satisfaction. One way is to ensure that claims are processed quickly and efficiently. This can be done by streamlining the claims process and ensuring that all relevant information is gathered upfront. Another way to improve customer satisfaction is to provide regular updates on the status of claims. This can be done via email, phone, or text message. Finally, it is important to be responsive to customer inquiries and concerns. Claims departments should have a dedicated customer service team that is available to address any issues that may arise.”
What are some common mistakes that claims examiners make?
An interviewer would ask "What are some common mistakes that claims examiners make?" to a/an Claims Examiner to get an idea of the type of mistakes that are commonly made in the field and how to avoid them. It is important to be aware of the common mistakes made in your field so that you can avoid making them yourself.
Example: “One common mistake that claims examiners make is failing to properly document the claim file. This can lead to problems down the road if the claim needs to be reviewed or appealed. Another common mistake is failing to thoroughly investigate the claim. This can result in an incorrect decision being made about the claim.”