25 Claims Examiner Interview Questions and Answers

The insurance industry is a backbone of the American economy, and claims examiners play a critical role in it. They work with insurance companies to review and process claims, ensuring that both the company and the customer are treated fairly.

If you’re looking for a job in the insurance industry, you’ll likely need to go through a claims examiner job interview. In this interview, you’ll be asked questions about your experience, your knowledge of the insurance industry, and your ability to handle customer service inquiries.

To help you prepare for your interview, we’ve put together a list of common questions and answers that you can expect to be asked.

1. Are you comfortable working with large amounts of data?

This question can help the interviewer determine whether you have the skills and experience to succeed in this role. Use your answer to highlight your ability to work with large amounts of data, analyze information and make decisions based on what you find.

Example: “Absolutely! I have extensive experience working with large amounts of data in my current role as a Claims Examiner. During this time, I’ve developed strong organizational skills and the ability to quickly analyze complex information. My attention to detail has enabled me to identify discrepancies and errors in claims documents and ensure accuracy throughout the process.

I also have experience using various software programs for data entry and analysis. This includes Microsoft Excel, Access, and SQL. With these tools, I am able to efficiently organize and manage large datasets, allowing me to make informed decisions about each claim. Furthermore, I am comfortable making adjustments to existing databases when needed.”

2. What are some of the most important qualities for a claims examiner?

Interviewers may ask this question to learn more about your qualifications for the role. They want to know if you have the skills and abilities necessary to succeed in their company. When answering, think of some of the most important qualities a claims examiner should possess. You can also mention any specific skills that are required for the job.

Example: “As a Claims Examiner, I believe the most important qualities are attention to detail, strong analytical skills, and excellent communication.

Attention to detail is essential for claims examiners because they must review documents and information closely to ensure accuracy and compliance with regulations. Strong analytical skills are also necessary in order to identify patterns and trends in data that can help inform decision-making. Finally, effective communication is key when working with clients and other stakeholders. As a Claims Examiner, it’s important to be able to explain complex concepts clearly and concisely so that everyone involved understands the process.”

3. How would you deal with a situation where the claims information you have doesn’t match up with what you know about the company’s policies?

This question can help the interviewer assess your critical thinking skills and ability to make decisions. Use examples from past experience where you had to analyze information, evaluate policies and make a decision based on what you knew at the time.

Example: “When dealing with a situation where the claims information I have doesn’t match up with what I know about the company’s policies, I would first take a step back and assess the situation. I would review all of the available data to determine if there is any evidence that could explain why the information does not match. If necessary, I would consult with other experts in the field or contact the policyholder for additional information.

Once I had gathered as much information as possible, I would then analyze it to see if there was an explanation for the discrepancy. If so, I would make sure to document my findings and adjust the claim accordingly. If no explanation could be found, I would discuss the issue with my supervisor to ensure that the correct decision is made in accordance with the company’s policies.”

4. What is your process for determining whether a claim is valid or not?

Interviewers may ask this question to learn more about your analytical skills and how you apply them to the job. Use your answer to highlight your critical thinking, problem-solving and attention to detail skills.

Example: “When determining whether a claim is valid or not, I use a systematic approach that involves gathering all the necessary information and analyzing it. First, I review the policy documents to ensure that the claim is within the scope of coverage. Then, I examine any available evidence such as medical records, police reports, witness statements, etc., to determine if there is sufficient proof to support the claim. Finally, I assess the credibility of the claimant by considering their past history with the company and other relevant factors. Throughout this process, I remain objective and impartial while ensuring that I am following all applicable laws and regulations. My goal is always to make sure that claims are handled fairly and efficiently.”

5. Provide an example of a time when you had to deal with a difficult claimant.

Interviewers may ask this question to see how you handle conflict. They want to know that you can be empathetic and use your interpersonal skills to resolve a situation without damaging the relationship with the claimant or their company. In your answer, try to show that you are able to remain calm under pressure and solve problems effectively.

Example: “I had a situation recently where I was dealing with a difficult claimant. The claimant had filed a claim for an accident that occurred several months prior, and the insurance company had denied their claim due to lack of evidence. The claimant was adamant that they were entitled to compensation and refused to accept the denial.

In order to resolve the issue, I took the time to thoroughly review all of the documentation provided by both parties and spoke with the claimant in detail about their case. After careful consideration, I determined that there was sufficient evidence to support the claimant’s position, and I was able to successfully negotiate a settlement between the two parties. This experience demonstrated my ability to remain calm under pressure and effectively mediate disputes.”

6. If you had to choose, which area of claims handling do you find most interesting?

This question is a way for the interviewer to learn more about your interests and how they align with their company’s goals. When answering this question, it can be helpful to mention an area of claims handling that you have experience in or one that you would like to gain experience in.

Example: “I find the investigative aspect of claims handling to be particularly interesting. I enjoy researching and analyzing data to identify potential areas of risk or fraud, as well as uncovering any discrepancies in a claim. This helps me to ensure that all parties involved are being treated fairly and accurately. In addition, I am passionate about helping customers get the best possible outcome from their claims. Being able to provide them with accurate information and guidance throughout the process is something I take great pride in. Finally, I also appreciate the challenge of staying up-to-date on the latest regulations and industry trends so that I can make informed decisions when evaluating claims.”

7. What would you do if you discovered that a colleague was intentionally falsifying claims information?

Interviewers may ask this question to assess your ethics and integrity. They want to know that you will report any unethical behavior in the workplace, even if it’s from a colleague. In your answer, explain how you would handle the situation while maintaining confidentiality.

Example: “If I discovered that a colleague was intentionally falsifying claims information, my first priority would be to ensure the safety and security of all involved. I would document any evidence I had uncovered and report it to the appropriate supervisor or department head. It is important to maintain confidentiality in such matters to protect everyone’s rights and interests.

Once the issue has been reported, I would work with the team to investigate further and take necessary action to rectify the situation. This could include additional training for the employee, disciplinary action, or termination depending on the severity of the offense. In addition, I would review existing policies and procedures to identify areas where improvements can be made to prevent similar incidents from occurring in the future. Finally, I would continue to monitor the situation closely to ensure that no further violations occur.”

8. How well do you think you would fit into a team of claims examiners?

This question is an opportunity to show your interpersonal skills and ability to work with others. When answering this question, it can be helpful to mention a specific example of how you worked well in a team setting.

Example: “I believe I would be a great fit for a team of claims examiners. I have extensive experience in the field, having worked as an examiner for over five years. During this time, I have developed strong communication and problem-solving skills that make me well suited to work with others on a team.

I am also highly organized and detail-oriented, which allows me to quickly assess claims and accurately determine their validity. My ability to stay focused and remain calm under pressure makes me an ideal candidate for working on a team of claims examiners. Finally, my passion for helping people is what drives me to do my best work every day. This enthusiasm will help create a positive environment within the team.”

9. Do you have any experience working with insurance software?

This question can help the interviewer determine your comfort level with using software to complete your work. If you have experience working with insurance software, share what type of software it was and how comfortable you were using it. If you don’t have experience working with insurance software, explain that you are willing to learn new software if necessary.

Example: “Yes, I have extensive experience working with insurance software. During my time as a Claims Examiner, I worked closely with multiple types of software to process and review claims. I am familiar with the various features and functions of the software, including data entry, document management, and reporting. I also understand how to use the software to ensure accuracy in claim processing and to quickly identify any discrepancies or errors. In addition, I am comfortable troubleshooting any issues that may arise when using the software.”

10. When investigating a claim, do you follow a specific process?

Interviewers may ask this question to learn about your experience with claims procedures. They want to know if you have the skills and knowledge necessary to perform well in their role. In your answer, share what steps you take when investigating a claim. Explain that you will also need to understand company policies and procedures for handling claims.

Example: “Yes, I do follow a specific process when investigating a claim. First, I review the policy to ensure that the claim is covered and assess the severity of the incident. Then, I gather all necessary documents such as police reports, medical records, witness statements, etc. After that, I analyze the information to determine if there is sufficient evidence to support the claim. Finally, I make an informed decision based on my findings and communicate it to the claimant.

I have extensive experience in claims investigation and am highly organized and detail-oriented. My ability to stay focused and methodically work through each step of the process has enabled me to successfully investigate numerous claims with accuracy and efficiency. I believe these skills would be invaluable to your team and make me an ideal candidate for this position.”

11. We want to improve our claim processing time. What changes would you make to your daily routine?

Interviewers ask this question to see how you would improve their company’s processes. Your answer should include specific changes you would make and the reasoning behind them.

Example: “I believe that improving claim processing time requires a combination of both process and technology improvements.

In my daily routine, I would focus on streamlining the review process by leveraging automation tools to reduce manual tasks. For example, I could use automated data entry software to quickly enter claims information into our system, which would save time and ensure accuracy. I would also look for ways to improve communication between departments, such as setting up regular meetings with other teams to discuss any issues or delays in the process. Finally, I would work to identify areas where we can make changes to existing processes to increase efficiency and speed up the overall process.”

12. Describe your experience working with different types of insurance policies.

Interviewers may ask this question to see if you have experience working with different types of insurance policies. They want to know that you can adapt to new situations and work effectively with a variety of clients. In your answer, describe the types of policies you’ve worked with in the past and how you handled them. Show that you’re flexible and willing to learn about new policies as needed.

Example: “I have extensive experience working with a variety of insurance policies. During my time as a Claims Examiner, I have worked with health, auto, and homeowners’ insurance claims. I am familiar with the different types of coverage offered by each policy and understand how to evaluate claims based on their individual terms.

I have also gained valuable knowledge in understanding the nuances of various state laws that can affect the outcome of an insurance claim. This has enabled me to provide accurate advice to clients regarding their rights and obligations under their policy. Furthermore, I have developed strong communication skills which allow me to effectively explain complex concepts to customers in a clear and concise manner.”

13. What makes you an excellent candidate for this claims examiner position?

Employers ask this question to learn more about your qualifications for the job. They want to know what makes you a good fit for their company and how you can contribute to its success. Before your interview, make a list of all your relevant skills and experiences that relate to this position. Think about which ones are most important for performing well in this role. Share these with the interviewer so they can see why you’re qualified for this job.

Example: “I believe I am an excellent candidate for this claims examiner position because of my extensive experience in the field. I have been a Claims Examiner for over five years, and during that time I have gained a deep understanding of the claims process and how to effectively evaluate and assess each claim. My expertise includes analyzing complex data, assessing risk factors, and making sound decisions based on evidence.

In addition to my professional experience, I also possess strong communication skills which are essential in this role. I am able to clearly explain the claims process to claimants, as well as negotiate with insurance companies and other stakeholders. I am confident in my ability to work with others to ensure all parties involved understand their rights and responsibilities.”

14. Which claims handling or insurance related job have you held in the past that you feel prepared you for this position?

This question is a great way for employers to learn more about your experience and how it relates to the position you’re applying for. When answering this question, be sure to highlight any skills or experiences that are relevant to the job description.

Example: “I have been an expert Claims Examiner for the past five years. During this time, I have gained extensive experience in all aspects of claims handling and insurance related jobs. My primary responsibility has been to review, analyze, and evaluate claims submitted by policyholders or claimants to determine coverage eligibility and liability.

I am also well-versed in state and federal regulations pertaining to claims handling and insurance policies. I have a strong understanding of how to interpret complex legal documents and contracts, as well as how to apply them to individual cases. In addition, I have developed excellent communication skills that enable me to effectively explain my findings to both internal and external stakeholders.”

15. What do you think is the most challenging part of being a claims examiner?

Interviewers ask this question to see if you have experience with the challenges of being a claims examiner. They want to know that you are prepared for the job and can handle its unique demands. In your answer, explain what you find challenging about the role and how you would overcome those challenges.

Example: “The most challenging part of being a claims examiner is staying organized and up to date with the ever-changing regulations. As a claims examiner, I understand that it is my responsibility to ensure that all claims are processed accurately and in compliance with applicable laws and regulations. This requires me to stay current on any changes or updates to those regulations so that I can properly assess each claim.

In addition, I must also be able to quickly and efficiently review claims while ensuring accuracy and fairness. This means that I need to have an eye for detail and be able to spot discrepancies between what is stated in the policy and what is actually happening in the claim. It also requires me to have strong analytical skills so that I can make sound decisions based on the facts presented.”

16. How often do you make mistakes when examining claims?

This question can help the interviewer determine how much experience you have as a claims examiner. It also helps them understand your level of confidence and self-awareness. When answering this question, it can be helpful to mention that you are always looking for ways to improve your work.

Example: “I strive to be as accurate and thorough as possible when examining claims. I understand that mistakes can happen, but I do my best to ensure they are kept to a minimum. To achieve this, I take the time to review all relevant information and double-check my work before submitting it for approval. I also stay up-to-date on any changes in regulations or policies so that I am aware of any potential issues that could arise. Finally, if I ever make a mistake, I take responsibility for it and use it as an opportunity to learn and improve my skills.”

17. There is a discrepancy in the information you have and what the claimant is telling you. How do you handle it?

Interviewers ask this question to see how you handle challenging situations. They want to know that you can remain calm and use your critical thinking skills to solve problems. In your answer, explain what steps you would take to resolve the issue.

Example: “When I encounter a discrepancy in the information, my first step is to make sure that all of the facts are correct. I will review the claimant’s documents and compare them with any other evidence available. If there is still a discrepancy, I will reach out to the claimant directly to discuss their situation and try to get to the bottom of the issue.

I understand that discrepancies can be difficult for claimants, so I always approach these conversations with empathy and respect. I strive to create an open dialogue where both parties feel comfortable expressing their thoughts and opinions. This helps me gain insight into the claimant’s perspective and allows me to better assess the validity of the claim.

Once I have gathered all of the necessary information, I evaluate the evidence objectively and make a decision based on the facts. My goal is to ensure that each claimant receives fair and accurate compensation for their losses.”

18. Explain how you would handle a situation where you have to deny a claim due to lack of evidence?

Interviewers may ask this question to see how you handle conflict and challenging situations. In your answer, try to show that you can be empathetic while also upholding the company’s policies.

Example: “When I am faced with a situation where I have to deny a claim due to lack of evidence, my first priority is to ensure that the claimant understands why their claim has been denied. I will take the time to explain the process and provide clear documentation outlining the reasons for denial.

I also make sure to be empathetic when communicating with claimants. I understand that this can be an emotional experience for them and strive to provide support throughout the process. I always try to be as transparent as possible about the decision-making process so that they feel informed and respected.

In addition, I use every available resource to investigate the validity of the claim. This includes researching relevant case law, consulting with colleagues, and reviewing any additional information provided by the claimant. By taking these steps, I am able to confidently determine whether or not there is sufficient evidence to approve or deny the claim.”

19. How do you stay up-to-date on the latest developments in claims handling and insurance policies?

Interviewers may ask this question to see if you are committed to your career and how much effort you put into staying informed about the industry. They want to know that you have a passion for your work, so they might look for signs of self-motivation in your answer. In your response, try to show that you enjoy learning new things and actively seek out information on insurance policies and claims handling techniques.

Example: “Staying up-to-date on the latest developments in claims handling and insurance policies is essential to being a successful Claims Examiner. I make sure to stay abreast of changes by reading industry publications, attending conferences, and taking continuing education courses. I also keep an eye out for new regulations or laws that may affect how claims are handled. Finally, I regularly network with other professionals in the field to ensure I’m aware of any updates or trends. By staying informed, I can provide my employer with the most accurate and timely advice possible.”

20. Talk about a time when you had to make a difficult decision while examining a claim.

Interviewers ask this question to see how you make decisions and whether you can use critical thinking skills. When answering, think of a time when you had to examine a claim that was challenging or complex. Explain the steps you took to analyze the situation and come up with an appropriate solution.

Example: “I recently had to make a difficult decision while examining a claim. The claimant was an elderly woman who had been in a car accident and needed medical care. She had submitted her claim for coverage, but the policy she had did not cover the full cost of her medical bills.

After carefully reviewing the policy documents and consulting with my supervisor, I determined that the best course of action would be to approve a partial payment of the claim. This allowed the claimant to receive some financial assistance towards her medical expenses, while still adhering to the terms of the policy.

The decision wasn’t easy, as it meant denying part of the claim and leaving the claimant responsible for the remaining costs. However, I felt confident that this was the right choice based on the information available to me at the time. It was important to me that I remain impartial and professional throughout the process, so I made sure to explain my reasoning to the claimant in detail.”

21. What methods do you use to ensure accuracy when dealing with claims information?

Interviewers may ask this question to assess your attention to detail and ensure you have the ability to perform accurate work. When answering, consider mentioning a specific method or two that you use to make sure you’re working with information carefully.

Example: “When dealing with claims information, accuracy is of the utmost importance. To ensure accuracy, I use a variety of methods. First, I always double-check all data entered into the system to make sure it is correct and up-to-date. I also review any supporting documentation for each claim, such as medical records or police reports, to verify that the information is accurate. Finally, I regularly compare my work against industry standards and best practices to ensure that I am following the most efficient processes. By using these methods, I can guarantee that all claims information is accurate and reliable.”

22. Describe your approach to prioritizing tasks as a claims examiner.

Interviewers may ask this question to learn more about your time management skills and how you approach a busy workday. When answering, it can be helpful to describe the steps you take when approaching a new task or project and how you prioritize what’s most important.

Example: “When I start my day at work, I always make sure to check my email for any urgent messages that require immediate attention. Then, I’ll look through all of my other emails to see if there are any tasks that need my attention. After checking my emails, I’ll review my calendar to see which appointments I have scheduled for the day. Once I’ve checked these things, I’m ready to begin working on my first task of the day.”

Example: “As a claims examiner, I understand the importance of prioritizing tasks in order to ensure that all claims are processed efficiently and accurately. My approach is to first assess the urgency of each claim based on its complexity and time sensitivity. Once I have determined which claims require immediate attention, I will then prioritize them accordingly. I also take into account any special circumstances surrounding the claim, such as if it involves a high-profile client or an urgent deadline. Finally, I make sure to keep track of my progress so that I can adjust my priorities as needed. By taking this organized and systematic approach, I am able to effectively manage my workload and ensure that all claims are handled promptly and professionally.”

23. Do you have any experience using analytics tools to analyze data related to claims?

Interviewers may ask this question to learn about your experience with specific software and how you apply it to your work. Use your answer to explain which tools you’ve used in the past and what you’re comfortable using if you haven’t worked as a claims examiner before.

Example: “Yes, I do have experience using analytics tools to analyze data related to claims. During my previous role as a Claims Examiner, I was responsible for utilizing various analytics tools such as Tableau and Excel to identify trends in claim data and make informed decisions about the best course of action.

I also have experience working with large datasets, which has enabled me to develop an understanding of how to interpret complex data sets and draw meaningful insights from them. Furthermore, I am familiar with the industry standards and regulations that are applicable to claims processing, allowing me to ensure compliance while making sure that all claims are handled efficiently and effectively.”

24. How do you handle customer complaints or disputes regarding denied claims?

Interviewers may ask this question to assess your customer service skills and ability to resolve conflicts. Use examples from previous experience to show that you can work with customers to find solutions, understand their concerns and make sure they’re satisfied with the outcome of their claim.

Example: “When it comes to customer complaints or disputes regarding denied claims, I believe in taking a proactive approach. First, I listen carefully to the customer’s concerns and try to understand their perspective. Then, I review the claim information thoroughly and explain why the claim was denied, using clear language that is easy for them to understand. Finally, if necessary, I offer solutions that may help resolve the dispute, such as filing an appeal or providing additional evidence. Throughout this process, I strive to maintain a professional yet empathetic attitude, so that customers feel heard and respected.

I also recognize the importance of staying organized when dealing with customer complaints. To ensure that all issues are addressed promptly and accurately, I keep detailed records of each conversation and document any changes made to the claim. This helps me stay on top of the situation and provide timely updates to both the customer and my supervisors.”

25. Are there any areas that you think need improvement in our current claims examination process?

This question can help the interviewer determine your critical thinking skills and how you approach problem-solving. It also helps them understand what areas of improvement may be necessary in their organization. When answering this question, it’s important to focus on specific examples that highlight your ability to analyze a situation and come up with solutions.

Example: “Yes, I believe there are areas that could be improved in the current claims examination process. First and foremost, I think it is important to ensure that all necessary information is collected from the claimant before a decision can be made. This includes verifying their identity, gathering evidence of any damages or losses, and obtaining any relevant medical records.

Additionally, I think it would be beneficial to have a clear set of criteria for evaluating each claim. This will help streamline the process by providing an objective standard for making decisions. Finally, I think having a system in place to track progress on each claim would be useful. This would allow the examiner to quickly identify which claims need more attention and prioritize them accordingly.”