Preview Questions Claims Adjuster | Role Specific Skill

Question 1: In the event of conflicting evidence during a claim investigation, what is the most appropriate course of action?

Which action should you take?

Choose only one option

Rely on client statements and close the case quickly

Accept the most favorable evidence without cross-verification

Settle the claim based on gut feeling

Seek additional evidence and perform a deeper analysis before making any conclusions

Question 2: What is the role of "Clarity in Language" in writing a claims report, and how do you ensure your report is easily understood by both technical and non-technical stakeholders?

Which action should you take?

Choose only one option

Clarity is achieved by using plain language, avoiding jargon, and structuring the report logically, ensuring that technical terms are defined

Clarity can be sacrificed to make the report more concise

Clarity is irrelevant as long as the report includes all the technical details

Clarity is only important if the report is being presented to the claimant

Question 3: 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 4: How should an adjuster handle sensitive information when documenting a claim?

Which action should you take?

Choose only one option

Publicly share sensitive information to ensure all parties are informed

Document sensitive information without any restrictions

Limit the disclosure of sensitive information to those directly involved in the claim

Include all sensitive information in the report for transparency

Question 5: In the context of insurance claims, what does the "duty to defend" require from an insurer?

Which action should you take?

Choose only one option

To provide legal defense for the insured in lawsuits related to covered claims

To negotiate settlement amounts with claimants

To cover all types of damages claimed

To disclose all claim-related information to the claimant

Question 6: Which of the following is a critical indicator of underwriting risk in a business liability claim?

Which action should you take?

Choose only one option

The age of the business and its revenue growth

The company's previous claim history and industry risk factors

The number of employees in the company

A reduction in workforce and increase in automation