Preview Questions Claims Adjuster | Role Specific Skill

Question 1: What is the role of surveillance in a claim investigation?

Which action should you take?

Choose only one option

Surveillance should be used only as a last resort to confirm fraudulent behavior

Surveillance should always be used to verify every aspect of the claim

Surveillance is not typically needed in claims investigation

Surveillance can only be used in high-value claims

Question 2: If an insurance policy contains an exclusion clause, what is the effect on a claim under those conditions?

Which action should you take?

Choose only one option

The exclusion does not apply, and the claim is fully covered

The claim will be covered after additional review

The claim is automatically processed but with reduced payout

The claim may be partially or fully denied based on the exclusion

Question 3: In the context of claims negotiation, what is the primary benefit of using a "win-win" approach?

Which action should you take?

Choose only one option

Minimizes the time spent on each claim

Ensures the Claims Adjuster maximizes the payout

Focuses solely on the policyholder's satisfaction

Seeks a mutually beneficial outcome, enhancing long-term relationships

Question 4: When assessing the risk of a home insurance claim, how important is the age of the home?

Which action should you take?

Choose only one option

Focus on the home's aesthetics and general condition

The age of the home is not important; focus only on the policy limits

Only consider the age if it's over 50 years old

The age of the home is crucial as older homes may have outdated electrical systems or plumbing, increasing risk

Question 5: When performing a risk assessment for an insurance claim, what is the primary factor to consider?

Which action should you take?

Choose only one option

The type of coverage purchased, regardless of the claim circumstances

The geographical location of the claimant without assessing external risk factors

The likelihood and potential severity of loss based on historical data and evidence

The claimant's personal history without considering the data

Question 6: When faced with a customer who challenges the terms of a claim settlement, what is the most effective negotiation tactic?

Which action should you take?

Choose only one option

Agree to the customer's terms to resolve the issue quickly

Escalate the case to avoid further conflict without trying to resolve it

Clarify the terms and conditions outlined in the policy and review the claim details together

Offer an immediate compromise without consulting the terms