17 Medical Claims Specialist Interview Questions and Answers

The medical claims specialist is a key figure in the business of healthcare. After a patient receives medical care, the medical claims specialist is responsible for ensuring that the insurance company reimburse the provider for the services rendered.

The medical claims specialist is a vital part of the healthcare industry, and the job requires a wide range of skills. In order to be successful in this role, you must be able to effectively communicate with patients, providers, and insurance companies. You must also be highly organized and detail-oriented.

If you’re interested in a career as a medical claims specialist, you will need to ace your job interview. In this guide, we will provide you with a list of medical claims specialist interview questions and answers to help you prepare for your interview.

Are you familiar with the medical billing cycle?

The interviewer may ask this question to assess your knowledge of the billing cycle and how you would apply it in your role as a medical claims specialist. Use your answer to highlight your experience with the billing cycle, including any specific software or processes that you use to manage billing cycles.

Example: “I have worked with several different billing cycles throughout my career, so I am familiar with the process. In my last position, I used a system called Medisoft to manage the billing cycle for our clients. This system allowed me to create invoices, track payments and monitor patient balances. It also helped me identify patients who were overdue on their bills and needed reminders about their outstanding balance.”

What are some of the most common reasons for medical claims to be rejected?

This question can help the interviewer assess your knowledge of how to handle common issues that arise in this role. Use examples from your experience or research to highlight your ability to solve problems and make decisions on behalf of the company.

Example: “The most common reasons for medical claims to be rejected are when a patient doesn’t have insurance, when they don’t provide all necessary information about their diagnosis or treatment plan and when they submit a claim after the deadline. I’ve also seen many instances where patients try to file multiple claims for the same service, which is against policy. In these situations, I always inform them of the issue and explain why it’s important to only file one claim per visit.”

How would you approach a patient who has not paid their outstanding medical bills?

Interviewers may ask this question to assess your customer service skills and ability to work with challenging patients. In your answer, demonstrate that you can remain calm and professional while still encouraging the patient to pay their bills.

Example: “I would first try to understand why they haven’t paid yet. If it’s because of a financial hardship, I would offer them payment plans or other options to help them get caught up on their bill. If they are simply refusing to pay, I would explain our policies for collections and let them know we will take legal action if necessary.”

What is the difference between a deductible and a copayment?

This question is a great way to test your knowledge of medical insurance. It also shows the interviewer that you understand how different aspects of an insurance policy work together. Use examples from your previous experience to show that you know what each term means and how they apply to your job.

Example: “A deductible is the amount of money you have to pay for healthcare before your insurance company starts paying. A copayment is a fixed fee you pay every time you visit a doctor or fill a prescription. For example, I had a patient who was on a high-deductible health plan. They were in a car accident and needed surgery. The hospital billed them $10,000, but their insurance only covered $2,500. So, they paid $5,000 out of pocket and then submitted a claim to their insurance company for the rest.”

Provide an example of a time when you had to deny a patient’s claim for medical services. Why did you make this decision?

This question can help the interviewer understand how you handle conflict and make decisions. Use your answer to highlight your critical thinking skills, ability to communicate clearly and compassion for patients.

Example: “When I was working as a medical claims specialist at my previous job, I had a patient who called me several times about her claim. She wanted to know why we hadn’t paid it yet, but she didn’t have any documentation that would support her claim. After speaking with her on multiple occasions, I realized that she wasn’t going to provide us with the information we needed to pay her claim. I decided to deny her claim so that we could use those funds to cover other patients who were in need of our services.”

If a patient has a high deductible, but they still need urgent care, how would you approach them about a payment plan?

This question can help the interviewer evaluate your customer service skills and ability to work with patients who may have financial challenges. Use examples from previous experience in how you approach these situations, and highlight your communication and problem-solving skills.

Example: “I would first explain that I understand their situation and empathize with them. Then, I would offer a payment plan option where they could pay for their medical bills over time. If they are unable to afford even this, I would try to find other ways to reduce the cost of care, such as offering discounts or finding free resources within the community.”

What would you do if you noticed a recurring error in a patient’s billing information?

This question can help the interviewer assess your problem-solving skills and ability to notice details. Use examples from previous work experience where you noticed a recurring error, investigated it and fixed it.

Example: “I once worked with a patient who had an unusual billing address that was different than their mailing address. I noticed this discrepancy when I was entering his information into our system but didn’t think much of it at first. However, as I continued to enter more information about him, I realized that he lived in one state but received mail from another state. This led me to investigate further and eventually discovered that he was receiving medical care from a facility in a neighboring state. After talking with him, we were able to change his billing information so that he could receive reimbursement for his treatment.

How well do you understand HIPAA regulations?

HIPAA, or the Health Insurance Portability and Accountability Act, is a set of federal regulations that govern how medical information can be stored and shared. An interviewer may ask this question to assess your knowledge of HIPAA and ensure you understand its importance in protecting patient privacy. In your answer, try to show that you are familiar with HIPAA’s requirements and why they’re important.

Example: “I am very familiar with HIPAA regulations because I worked at my previous employer for three years as a claims specialist. My team was responsible for ensuring all documents were properly encrypted before sending them electronically. We also had to shred any paper copies we generated so no one could access private health information. These rules are in place to protect patients’ privacy, which I think is extremely important.”

Do you have experience using claims processing software?

This question can help the interviewer determine your level of experience with medical claims software. If you have no prior experience, you can describe what you would do if you were hired and needed to learn how to use the software quickly.

Example: “I’ve used several different types of software in my previous roles, but I’m most comfortable using MediClaims. It’s a great system for managing patient information and processing claims. In my last role, I was tasked with training new employees on how to use the software. I found that it helped them become more familiar with the program as they worked through their daily tasks.”

When reviewing a patient’s medical history, do you prefer to read hard copies or access digital files?

This question can help the interviewer determine how comfortable you are with technology and whether you have experience using digital files. If you prefer to work with hard copies, explain that you’re willing to learn new software if necessary. If you prefer working digitally, mention your comfort level with various types of software programs.

Example: “I prefer reading hard copies because I find it easier to make notes on paper than on a computer screen. However, I am very familiar with several different types of medical record software, including those that allow me to access patient records electronically. In my previous role as a claims specialist, I worked primarily with electronic files but also reviewed hard copies when needed.”

We want to improve our customer service reputation. Tell me about a strategy you would use to improve patient satisfaction with our claims processing procedures.

Interviewers may ask this question to gauge your customer service skills and how you would apply them to their organization. Use examples from previous experience where you helped customers with claims processing or other administrative tasks.

Example: “I have a lot of experience helping patients navigate the insurance process, so I know that it can be confusing for some people. In my last role, I implemented a new system for our patient portal that allowed us to provide more detailed information about claim status updates and answer common questions before they asked them. This resulted in fewer calls to our call center and improved overall satisfaction among our patients.”

Describe your experience working with a team to process claims for multiple patients at once.

Working as a medical claims specialist often requires you to work with your team members to process multiple patient claims at once. Employers ask this question to make sure you have experience working in teams and collaborating with others to complete tasks. Use your answer to explain how you’ve worked on a team before and what skills you use to help you collaborate effectively.

Example: “In my previous role, I was part of a small claims department that processed multiple patients’ claims at the same time. We used our communication skills to discuss each claim and determine which ones we could approve and which ones needed further review. This helped us streamline our processes and ensure we were making the best decisions for our patients.”

What makes you an ideal candidate for a medical claims specialist 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 reasons why you are the best candidate for the job. Consider highlighting any relevant experience or skills that match what they’re looking for in an employee.

Example: “I am passionate about helping people, which is why I became a medical claims specialist. In my previous role, I helped patients understand their insurance policies so they could get the care they needed. I also have extensive knowledge of medical terminology and billing codes, which makes me well-suited for this position.”

Which medical fields do you have the most experience working with?

This question can help the interviewer determine if your experience aligns with the job description. It also helps them understand what you’re most passionate about and how much time you’ve spent working in this field. When answering, be sure to mention any medical fields that are not listed in the job description but that you have experience in.

Example: “I have worked primarily with physical therapy claims for the past five years. However, I also have some experience working with occupational therapy claims and speech therapy claims.”

What do you think is the most challenging part of this job?

Employers ask this question to see if you are aware of the challenges that come with working in a medical claims department. They want someone who is willing to take on these challenges and use their skills to overcome them. When answering, think about what you find most challenging about this job and how you would handle it.

Example: “The most challenging part of this job for me is when I have to tell patients they will not be receiving payment from their insurance company. It’s hard to know that we can’t help them get the money they need to pay for their treatment. However, I try to make sure they understand that I am doing everything I can to ensure they receive reimbursement. I also offer to answer any questions or concerns they may have.”

How often do you make mistakes when processing claims?

This question can help the interviewer determine how much experience you have in this role. It’s important to be honest about your mistakes, but also highlight what you learned from them and how they helped you improve your skills as a medical claims specialist.

Example: “I make mistakes every once in a while when processing claims. However, I am always eager to learn from my mistakes and use that knowledge to improve my future work. For example, last month I made an error on a patient’s claim where I forgot to include their deductible. The patient called me to ask why they hadn’t received their reimbursement yet, so I immediately went back into our system to correct the mistake. After doing some research, I realized that I had forgotten to apply the patient’s copayment to their account. Once I fixed both of these issues, the patient was able to receive their reimbursement within two weeks.”

There is a claim you don’t know how to process. What do you do?

This question is a great way to see how you would handle an unfamiliar situation at work. It’s important that you show your ability to ask for help and learn from others when necessary.

Example: “I have worked in this industry for five years, so I am familiar with most of the claims we process here. However, if there was one I didn’t know how to do, I would first try to find someone who does. If no one else knows how to process it, I would look up the information online or call the insurance company to get more details about the claim. I would then research any other similar claims to figure out how to process it.”