17 Claims Consultant Interview Questions and Answers

As a claims consultant, you will be responsible for investigating insurance claims and determining whether they are valid. You will also be responsible for negotiating settlements and providing expert testimony in court.

To be successful in this role, you will need to have strong analytical and problem-solving skills. You will also need to be able to communicate effectively, both in writing and verbally.

If you are interested in a career as a claims consultant, you will need to be prepared to answer a variety of interview questions. In this guide, we will provide you with some sample questions and answers that you can use to prepare for your interview.

Are you familiar with the claims process in this state?

Interviewers may ask this question to see if you have experience working in their state. If they do, it’s important that you show them that you’re familiar with the process and how it works. You can answer this question by telling them about your previous experience working in their state or any other states where you’ve worked.

Example: “I am very familiar with the claims process in this state because I have worked here before. In my last position, I helped a client file a claim for an injury they sustained at work. The company was able to get compensation from the insurance company after we filed the claim.”

What are some of the most important qualities for a claims consultant to have?

Interviewers may ask this question to learn more about your qualifications for the role. They want to know what skills you have that will help you succeed in their company. When answering, think of some qualities that are important to you and how they relate to claims consulting.

Example: “I believe one of the most important qualities a claims consultant can have is empathy. I’ve worked with many clients who were going through difficult situations, so it’s important to me to be able to understand their emotions and provide them with support. Another quality I find essential is communication. As a claims consultant, we work with many different people from all over an organization. It’s important to me that everyone feels comfortable speaking up when they need something.”

How would you handle an employee who is resistant to filing a claim?

This question can help the interviewer assess your interpersonal skills and ability to manage a team. Use examples from past experience where you helped an employee overcome their reluctance to file a claim or helped them understand why filing a claim was important.

Example: “In my last role, I had an employee who didn’t want to file a claim because they were worried about losing their job. I spoke with them privately and explained that if they filed a claim, it would be confidential and no one else in the company would know. They agreed to file the claim, and we worked together to create a plan for how they could improve their performance so they wouldn’t lose their job.”

What is your experience with using insurance software?

This question can help the interviewer determine your comfort level with using software to complete tasks. Your answer should include a brief description of what you used and how comfortable you were with it.

Example: “I’ve worked in my current position for five years, and during that time we have upgraded our insurance software three times. Each upgrade was more user-friendly than the last, but I still prefer to use paper records when possible because they are easier to organize and find later. However, I am very comfortable using software to enter data and calculate claims.”

Provide an example of a time when you successfully resolved a claim issue.

Interviewers ask this question to learn more about your problem-solving skills and how you resolve issues. Use examples from previous work experience or include a time when you helped a friend solve a problem.

Example: “At my last job, I had a client who was having trouble with their insurance company because they were denied coverage for a medical procedure. The patient called me in desperation, so I immediately contacted the insurance company on their behalf. After speaking with the claims department, I learned that the patient’s policy didn’t cover the procedure but there was an alternative treatment that would be covered under their plan. I explained this information to the patient and advised them to seek out the new treatment.”

If an employee files a claim, how would you ensure that the claim is processed fairly?

Interviewers may ask this question to assess your ability to handle conflict and ensure that employees are treated fairly. In your answer, try to show the interviewer that you can be fair and impartial when handling claims.

Example: “I would first make sure I understood all of the details of the claim. Then, I would speak with both the employee and their manager about what happened. If it was a simple misunderstanding, I would work with everyone involved to find a solution. However, if there were any conflicting accounts or evidence, I would investigate further before making my decision.”

What would you do if you noticed a pattern of claims related to a specific risk factor?

Interviewers may ask this question to assess your ability to identify and address risk factors in a claims process. Use your answer to highlight your analytical skills, problem-solving abilities and attention to detail.

Example: “I would first determine if the pattern of claims is due to an increase in the number of incidents or if there’s been an increase in severity. If it’s both, I’ll look at the company’s current insurance policy to see if we have adequate coverage for the risk factor. If not, I will recommend that my employer purchase additional coverage or implement preventative measures to reduce the risk factor.”

How well do you understand the concept of subrogation?

Subrogation is a legal concept that refers to the process of one party recovering money from another party. Subrogation can be important in claims consulting because it allows you to recover funds for your client and then use those funds to pay them back. An interviewer may ask this question to see if you have experience with subrogation or if you need more training on the subject. In your answer, try to show that you understand the basic concepts of subrogation but also that you are willing to learn more about it if necessary.

Example: “I am familiar with the concept of subrogation, although I haven’t had much experience using it in my previous roles. However, I would welcome the opportunity to learn how to apply it in my work as a claims consultant.”

Do you have experience working with vendors to negotiate insurance rates?

This question can help the interviewer determine your negotiation skills and ability to work with vendors. Use examples from previous experience to highlight your communication, problem-solving and analytical skills.

Example: “In my last position as a claims consultant, I worked with several insurance companies to negotiate rates for their clients. One of my clients was paying high premiums because they had an older client base. We decided to target younger customers who were looking for affordable health care options. After negotiating with multiple vendors, we found one that offered lower premiums for our client while also attracting new customers.”

When investigating a claim, what is your process for collecting and analyzing evidence?

Interviewers may ask this question to understand how you approach your work and what methods you use. Your answer can show them that you have a process for completing tasks, which can be important in claims consulting because it’s often an ongoing job. To answer this question, think about the steps you take when investigating a claim. Explain your thought process as you go through each step.

Example: “When I’m working on a new case, I first read all of the information provided by the client. Then, I review any evidence they’ve submitted with their claim. Next, I contact the insurance company to request more information about the incident or accident. If necessary, I will also speak with witnesses or other people involved in the situation. After collecting all of the information, I analyze it to determine whether there is enough proof to support the claim.”

We want to improve our claims process to reduce costs and improve employee satisfaction. What changes would you make to our current system?

This question is an opportunity to show your problem-solving skills and ability to make improvements. You can answer this question by describing the steps you would take to improve the claims process, including how you would measure success.

Example: “I would start by analyzing our current system to understand why it’s inefficient. I would then create a new plan that reduces costs while improving employee satisfaction. To measure success, I would compare the cost of processing claims before and after my changes.”

Describe your experience working with employees from diverse backgrounds.

Employers ask this question to see if you have experience working with people from different backgrounds. They want to know that you can work well with others and respect their unique perspectives. In your answer, share a specific example of how you worked with someone who was different than you. Explain what steps you took to ensure the employee felt comfortable in the workplace.

Example: “In my previous role as a claims consultant, I had an employee who was born outside of the United States. She spoke English fluently but sometimes struggled with grammar. When she would write reports or correspond via email, I would proofread her work for any grammatical errors. This helped her feel more confident in her writing skills and understand the importance of proper grammar.”

What makes you stand out from other candidates for this position?

Employers ask this question to learn more about your qualifications and how you can contribute to their company. Before your interview, make a list of the skills and experiences that qualify you for this role. Focus on what makes you unique from other candidates and highlight any transferable skills or certifications you have.

Example: “I am passionate about helping others, which is why I chose to pursue a career in insurance. In my previous position as an underwriter, I helped clients understand their policies and find solutions to their claims. This experience has given me valuable insight into the claims process and how to help customers navigate it. I also hold two professional designations in insurance, which shows your company that I’m committed to my field.”

Which insurance companies have you worked with in the past?

This question can help the interviewer determine if you have experience working with their company. It can also show them how much experience you have in general, which may be helpful for determining your salary. When answering this question, list companies that are similar to the one you’re interviewing with and include any smaller or local companies you’ve worked with.

Example: “I’ve worked with several large insurance companies including State Farm and Liberty Mutual. I’ve also worked with a few small businesses like The Insurance Store and Insure U. These companies all had different processes and procedures, but they were all equally important to me.”

What do you think is the most challenging part of being a claims consultant?

This question can help the interviewer understand what you think is challenging about your job and how you approach it. Your answer can also show them that you are aware of the challenges in this role and have strategies for overcoming them.

Example: “The most challenging part of being a claims consultant is when I have to tell clients that their insurance company isn’t going to cover something they were expecting to be covered by their policy. It’s important to me to make sure my clients know that I am doing everything I can to advocate on their behalf, but sometimes there just aren’t enough resources to go around. In these situations, I try to provide as much information as possible so they feel like they’re making an informed decision.”

How often do you make recommendations to insurance carriers?

This question can help the interviewer understand how often you’ll be interacting with clients and insurance carriers. It can also show them your communication skills, as you may need to discuss recommendations with a client or carrier in person or over the phone. When answering this question, it can be helpful to mention a specific situation where you made a recommendation to an insurance carrier that helped a client.

Example: “I make recommendations to insurance carriers at least once every two weeks. In my last position, I worked with a client who had been injured in a car accident. The driver of the other vehicle was uninsured, so our client’s claim went to their insurance carrier. After reviewing all of the information from the case, I recommended that they pay out on the claim because there were no extenuating circumstances that would prevent them from doing so.”

There is a claim that you don’t know how to handle. What is your process for researching the issue and coming to a solution?

Interviewers may ask this question to see how you handle challenges in the workplace. They want to know that you can use your problem-solving skills and research abilities to find solutions to problems quickly. In your answer, explain what steps you would take to solve the issue and provide an example of a time when you had to do so.

Example: “If I didn’t know how to handle a claim, I would first try to understand the situation by asking questions. If it was something simple, I could probably figure out the solution on my own. However, if it was more complex, I would look for resources within the company or outside sources to help me learn about the issue. Then, I would come up with a plan to solve the problem based on my research.”