Preview Questions Claims Adjuster | Role Specific Skill

Question 1: What's the best practice when dealing with conflicting statements in a claim investigation report?

Which action should you take?

Choose only one option

Ignoring the conflicting statements and proceeding

Mentioning the conflict and leaving it unresolved

Documenting the conflict and seeking further clarification

Presenting the statements equally without analysis

Question 2: What is the role of "Fact-Checking" in claims report writing, and how do you validate the accuracy of the information before including it in a report?

Which action should you take?

Choose only one option

Fact-checking should be skipped to save time if the claim seems straightforward

Fact-checking ensures that all data and statements are verified against reliable sources, such as police reports or medical records

Fact-checking is only necessary for high-value claims, not routine ones

Fact-checking is irrelevant as long as the claimant agrees with the information

Question 3: How do you manage a claim investigation where the insured is uncooperative or evasive?

Which action should you take?

Choose only one option

Report the issue to the claims management team for further review

Proceed with the claim based on available evidence

Close the case immediately due to lack of cooperation

Ignore the insured's uncooperativeness and proceed with standard procedures

Question 4: How do you perform "Fraud Risk Assessment" in high-value claims, and what steps do you take to prevent fraudulent claims from being paid?

Which action should you take?

Choose only one option

Fraud risk assessment is only necessary for claims above a certain value threshold

Fraud risk assessment is unnecessary if the claimant has been with the insurer for a long time

Fraud risk assessment is performed by analyzing inconsistencies, performing background checks, using predictive analytics, and involving legal experts when necessary

Fraud risk assessment is irrelevant and claims should be paid out quickly

Question 5: How do you assess the potential risk of fraudulent claims when investigating a loss event?

Which action should you take?

Choose only one option

Use data analytics and past claim history to identify patterns and inconsistencies

Disregard potential fraud if the claimant is cooperative

Investigate fraud only in high-value claims

Rely on the claimant's word and the initial report provided

Question 6: How do you assess the credibility of an expert opinion used in a claim investigation?

Which action should you take?

Choose only one option

Verify the expert's credentials, experience, and relevance to the specific case

Trust the expert's opinion if they are well-known in the industry

Accept the expert's opinion if it aligns with the claimant's statements

Use expert opinions only for high-value claims