Insurance claims handlers ensure claims are processed efficiently and reimbursements are made for valid claims. They make the decision on whether a claim is valid or not by investigating for any fraudulent activity.
Another large part of an insurance claims handler’s job is to coordinate services. This includes making sure the policyholder has filed their claim, setting up services like hiring professionals to make a home safe, or making sure stolen items are reimbursed.
Landing a job as an insurance claims processor can be highly competitive. The people hiring you will want to see proof that you have the knowledge, skills, and experience to do this fast-paced, detail-oriented job. During the interview, one of the most important parts will be being asked how you would handle common tasks and problems that claims processors face.
In this article, we’ll take an in-depth look at 20 of the most frequently asked insurance claims processor interview questions I’ll provide tips on what hiring managers are looking for in strong responses, as well as examples to help you craft your own winning answers. With preparation and practice, you’ll be ready to impress interviewers and land the claims processor job you want.
Common Insurance Claims Processor Interview Questions
Here are 20 of the top questions you’re likely to encounter when interviewing for insurance claims processor roles:
-
What experience do you have with processing insurance claims?
With this question, the interviewer wants to understand your level of familiarity with insurance claims processing. They are looking for candidates who have worked directly with processing claims and managing the details involved.
If you don’t have direct insurance experience talk about any related skills from past jobs that are relevant like working with numbers, attention to detail, interacting with customers, and navigating regulatory requirements. Provide specific examples of claims processing tasks you have experience with.
-
Describe your approach to verifying the accuracy of a claim before submitting it for payment.
In this question, the interviewer wants to know how you make sure that every claim is complete, legal, and free of mistakes before sending it through. They want you to be organized and methodical, and your attention to detail should show.
In your response, walk through the key checks and reviews you would conduct, such as double-checking calculations, confirming all required documents are present, and cross-referencing with databases. Emphasize accuracy as your top priority.
-
How do you handle difficult conversations with claimants who are unhappy with their coverage or benefits?
Interviewers want to see that you can navigate tricky conversations with empathy and professionalism. Share examples of times you successfully handled upset claimants by listening to their concerns, communicating based on a clear understanding of policies, and working to find solutions.
Emphasize that you remain calm under pressure and know when to involve a supervisor when needed. Reassure the interviewer that keeping the customer satisfied is always your goal.
-
Explain how you would go about researching and resolving complex claims issues.
Here the interviewer is assessing your problem-solving skills. Respond by walking through how you methodically gather information, analyze details, consider options, and make a reasoned decision on the right solution.
You can also talk through an example of a complex issue you successfully resolved. Demonstrate critical thinking, creativity, and perseverance.
-
Are you familiar with any specific software programs used in the claims processing industry?
The interviewer wants to know if you have experience with claims management systems and can quickly learn new programs. Mention any specific claims systems you’ve used and talk about your ability to adeptly pick up new software skills.
Highlight any training courses or certifications you have completed to stay up-to-date on the latest claims processing technology.
-
What strategies do you use to stay organized when managing multiple claims at once?
Keeping numerous claim details straight can be a challenge. The interviewer wants to hear about tools and techniques you utilize for organization and time management.
Talk through helpful systems like creating tracking spreadsheets, filing methods, prioritizing with urgency levels, using calendar reminders, or collaborating with teammates. Show you have what it takes to seamlessly multi-task.
-
How do you ensure that all relevant information is included in a claim submission?
Here the focus is on your meticulous attention to detail. Share the careful processes you go through, such as comprehensively reviewing all documents, creating submission checklists, double-checking with claimants if any info is missing, using tracking software, and coordinating with colleagues. Demonstrate your diligence.
-
Describe a time when you had to explain a complicated policy to a claimant.
The interviewer is gauging your customer service skills and ability to clearly explain complex topics. Briefly tell the story of a time you successfully clarified confusing details for a claimant who was struggling to understand their policy’s provisions.
Share how you patiently answered all their questions and provided additional helpful materials so they felt supported. Showcase your communication abilities.
-
Do you have experience working with confidential medical records?
Privacy is critically important when claims include medical documentation. The interviewer needs to know you understand medical confidentiality laws and have experience handling sensitive information with care.
If you have worked with medical records, provide examples demonstrating your strict adherence to information security protocols. If not, share how you have managed other private data responsibly.
-
What steps do you take to verify the identity of a claimant?
Fraud prevention is top-of-mind. Discuss the steps you take such as checking IDs, running database searches, and performing additional verification checks until you can confirm an individual’s identity beyond any doubt.
Emphasize that you are vigilant about following processes to catch fraudulent claims.
-
How do you handle discrepancies between the information provided by a claimant and the information in our system?
The interviewer wants to see how you troubleshoot and resolve inconsistencies. Explain how you would methodically analyze the details from both sources, consult policy documents, and communicate with the claimant to determine the accurate information.
Emphasize how important resolving discrepancies is for smooth claims processing and preventing payment issues down the road.
-
What strategies do you use to identify fraudulent claims?
Share proactive measures you take to detect fraud, such as looking for missing or inconsistent information, contacting references, and being alert to suspicious claims patterns. Demonstrate that you are constantly on the lookout for fraudulent warning signs.
You can briefly share an example of how you helped uncover fraudulent activity. Showcase your vigilance and critical thinking.
-
How do you prioritize tasks when there is not enough time to complete everything?
Interviewers want to understand your time management abilities. Walk through how you leverage methods like urgency-based task prioritization, delegation, calendars, reminders, and collaboration with your team to ensure the most mission-critical work gets done on time when your plate is overflowing.
Emphasize efficiency, organization, and communication as key priorities.
-
We want to improve our customer service. What experience do you have with process improvement?
This question looks at your ability to analyze processes and implement positive changes. Talk through examples of how you have improved customer service levels or streamlined processes in past jobs by identifying issues, brainstorming solutions, collaborating cross-functionally, incorporating technology, creating training programs, and tracking results.
Tout successes you contributed to, like increased customer retention.
-
What metrics do you use to measure the success of a claims processing team?
Share key performance indicators you would track, like claims processing turnaround times, customer satisfaction scores, first-call resolution rates, and accuracy percentages. Discuss how you analyze trends in the metrics to guide process improvements and additional staff training.
Emphasize how you provide transparent data to the team and recognize achievements. Show you understand success measurement.
-
Have you ever managed a project related to improving the efficiency of the claims processing process?
Even if you don’t have direct project management experience, speak to how you would approach streamlining workflows or automating manual processes if given the chance. Talk through steps like identifying bottlenecks, mapping improved procedures, outlining timelines, and selecting tools to boost efficiency.
Highlight your problem-solving, collaboration, and analytical abilities.
-
What strategies do you use to stay up-to-date on changes in the claims processing industry?
Demonstrate you make continuous learning and professional development a priority by listing newsletters you subscribe to, industry groups you follow, regular research you conduct, and seminars you attend.
Underscore how important proactively staying current on regulations and best practices is for claims processing excellence.
-
Tell me about a time when you had to collaborate with other departments within the company to resolve a claim issue.
Collaboration is key for effective claims handling. Briefly tell the story of a time you worked across departments to solve a particularly tricky issue. Discuss how you communicated the problem, coordinated fact-finding, maintained patience, and kept everyone aligned until the optimal solution was reached.
Show yourself to be a strong team player.
-
How do you handle situations where a claimant disagrees with the decision made by the insurer?
The interviewer wants to see you can show empathy while still upholding the insurer’s stance. Discuss how you would listen carefully to understand the claimant’s frustration, explain the reasoning, explore options, and follow up after the discussion.
Reassure the interviewer that you can de-escalate disagreements professionally.
-
Describe your experience with developing training materials for new claims processors.
Even if you have not created formal training programs before, talk through the approach you would take if tasked with onboarding new claims staff, such as presenting key procedures, creating quick-reference guides, encouraging shadowing, and being available to answer questions.
Demonstrate you are willing and able to help new team members
A word of warning when using question lists.
Question lists offer a convenient way to start practicing for your interview. Unfortunately, they do little to recreate actual interview pressure. In a real interview you’ll never know what’s coming, and that’s what makes interviews so stressful.
Take your interview prep to the next level.
Get the realistic interview experience you need to master the interview.
What Does a Medical Insurance Claims Processor Do? : Dental & Other Insurance Questions
FAQ
What is the main goal of a claims processor?
Why do you want to work in insurance claims?
What questions do claims processors ask?
Most interviews will include questions about your personality, qualifications, experience and how well you would fit the job. In this article, we review examples of various claims processor interview questions and sample answers to some of the most common questions. What does a typical day involve for a claims processor?
What does an insurance claims processor do?
This question is important as it helps the hiring manager understand how well you collaborate and communicate with other teams. The role of an insurance claims processor often involves coordinating with various departments or outside professionals to gather information, resolve discrepancies, and process claims accurately and efficiently.
What skills do insurance claims processors need?
Orderliness and attention to detail are critical skills for an insurance claims processor. In this role, you’ll likely be handling a large volume of claims simultaneously, each at different stages of the process.
What is a typical day for a claims processor?
Example: “A typical day for a claims processor may involve reviewing and processing insurance claims, communicating with claimants and insurance companies, and maintaining records. Claims processors must be detail-oriented and able to work independently. They may also need to resolve disputes between claimants and insurance companies.”
