Preview Questions Claims Adjuster | Role Specific Skill

Question 1: What is the best strategy when the claimant offers a low settlement figure, and you need to raise the amount?

Which action should you take?

Choose only one option

Find common ground by explaining the reason for your increase

Counter-offer with the highest possible settlement

Refuse to negotiate and escalate the claim

Accept the low offer to avoid further negotiations

Question 2: Which statute primarily governs the handling of health insurance claims in the United States?

Which action should you take?

Choose only one option

ADA (Americans with Disabilities Act)

HIPAA (Health Insurance Portability and Accountability Act)

SOX (Sarbanes-Oxley Act)

ERISA (Employee Retirement Income Security Act)

Question 3: 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

Question 4: How do you incorporate historical loss data into your risk assessment for new claims?

Which action should you take?

Choose only one option

Only use historical loss data when the policyholder requests it

Use historical loss data to make assumptions about the current claim without further investigation

Ignore past loss data, as each claim is independent

Analyze patterns from past claims to adjust the risk assessment for similar future claims

Question 5: When dealing with catastrophic claims, what is the first step in the investigation process?

Which action should you take?

Choose only one option

Review the claimant's previous claims history

Determine the scope of damage and number of affected parties

Assess the environmental impact on surrounding areas

Evaluate the financial stability of the insurer

Question 6: How do you ensure compliance with regulatory requirements when documenting claims?

Which action should you take?

Choose only one option

Only document what the claimant provides

Follow internal company guidelines without checking external regulations

Ignore regulations unless a dispute arises

Regularly consult with legal and compliance teams to ensure adherence to all regulations