Top 4 Claims Interview Questions
Browse 4 real-world technical and behavioral interview questions about Claims. Review scenarios, edge cases, and architectural best practices.
Take me through what a payer does with a claim after you submit it, and how you keep denials from piling up.
Adjudication validates the member and provider, applies benefit and contract rules, prices the claim and returns a remittance explaining each line. Denials are prevented at the front end by eligibility and prior authorisation checks, and managed at the back end by triaging root causes rather than reworking claims.
Walk me through a claim from first notification to closure, and tell me what the reserve is doing at each stage.
A claim moves from notification through coverage verification, adjudication, payment and closure, carrying a case reserve that is the handler's current estimate of what remains to be paid. It moves whenever information arrives, and every movement is a dated financial transaction.
A claim is notified and nobody yet knows what it will cost. Why does the system have to put a number on it immediately, and what happens to that number?
A reserve is money recognised in the accounts on the strength of an estimate, so the insurer's reported result depends on it long before anything is paid. It moves as the file develops, every movement is itself reportable, and the history of movements matters as much as the current figure.
You have paid your policyholder in full and the accident was the other driver's fault. Walk me through what your claims system now has to do about that.
Pay the insured first, then pursue the party at fault as subrogation, tracking the recovery as a separate asset against the same claim rather than as a credit that erases the payment. Salvage, the insured's uninsured excess and the eventual partial settlement all have to be allocated, and the gross figure must survive.