Preview Questions Claims Adjuster | Role Specific Skill

Question 1: In a case where a customer disagrees with the claim decision due to policy exclusions, what is the best course of action?

Which action should you take?

Choose only one option

Suggest that the customer contact legal representation immediately

Explain the exclusions in detail and offer alternative options within policy limits

Ignore the disagreement and proceed with the original decision

Accept the customer's view and settle the claim outside policy terms

Question 2: How do you ensure compliance with "State and Federal Regulations" in claims processing, particularly when dealing with interstate claims?

Which action should you take?

Choose only one option

I assume the company's legal team will handle compliance and don't review the regulations

I stay informed about the latest state and federal regulations and ensure that claims are processed according to these laws

I rely on the claimant to ensure compliance with all regulations

I only follow state regulations and ignore federal guidelines

Question 3: How does the "duty to mitigate" affect the handling of a loss in property insurance claims?

Which action should you take?

Choose only one option

It allows the insurer to deny claims based on policy exclusions

It obligates the insurer to fully compensate for all losses without limitation

It requires the policyholder to take reasonable steps to minimize further loss

It mandates that the insurer covers all restoration costs

Question 4: In cyber liability policies, what is the typical scope of ?first-party? versus ?third-party? coverage?

Which action should you take?

Choose only one option

First-party covers client liability

First-party addresses damages to policyholder

Third-party pays for all insured losses

Third-party protects company infrastructure

Question 5: When addressing discrepancies found during a claim investigation, where should this information be documented in the report?

Which action should you take?

Choose only one option

Appendices

Executive Summary

Recommendations

Findings

Question 6: Which of the following best describes the principle of "BATNA" in negotiation, and how should a Claims Adjuster utilize it during claim settlements?

Which action should you take?

Choose only one option

Best Assured Negotiation Agreement; use it to guarantee policyholder satisfaction

Basic Agreement to Negotiated Action; use it to set minimum settlement amounts

Best Alternative to a Negotiated Agreement; use it to understand fallback options if negotiations fail

Best Actuarial Negotiation Assessment; use it to determine claim payouts