Preview Questions Claims Adjuster | Role Specific Skill

Question 1: What action should be taken if the investigation reveals fraud during the claim process?

Which action should you take?

Choose only one option

Ignoring the fraud and proceeding with the claim

Reporting the fraud to relevant authorities and documenting it

Continuing with the claim process but delaying payment

Allowing the claimant to provide additional evidence

Question 2: During negotiations, how can a Claims Adjuster effectively use the "anchoring" technique to influence the settlement amount?

Which action should you take?

Choose only one option

Remaining silent after making an offer to pressure the claimant

Using data and evidence to support the initial offer

Presenting a high initial offer to set the stage for lower subsequent offers

Showing empathy to build trust and encourage higher settlements

Question 3: How do you handle documentation when there is a long delay in receiving necessary medical records from the claimant?

Which action should you take?

Choose only one option

Close the claim until the medical records arrive

Proceed without the medical records to speed up the process

Ignore the delay and make assumptions based on previous claims

Document the delay and continue following up until the records are received

Question 4: When reviewing a suspicious claim, what is the most important step for a Claims Adjuster in BFSI?

Which action should you take?

Choose only one option

Focusing on claims that have been automatically pre-approved

Approving the claim based on the claimant's history with the insurer

Relying primarily on the claimant's version of events

Conducting a thorough investigation of all available evidence and documents

Question 5: Under ERISA, what is the significance of the "fiduciary responsibility" for claims adjusters handling pension claims?

Which action should you take?

Choose only one option

They must act in the best interest of the plan participants and beneficiaries

They are responsible for investing the pension fund's assets

They are required to maximize the insurer's profits

They must follow the instructions of the policyholder without question

Question 6: How can an adjuster ensure that a claim file is ready for an audit?

Which action should you take?

Choose only one option

Focus only on the financial details and limit the documentation

Keep the file organized, include all supporting documents, and ensure they are up-to-date

Skip non-essential documentation and reduce the file size

Only include documentation if the claimant agrees to it