Claims Manager

These interview questions in Claims Manager will help you to prepare for different jobs in Claims Management.

Q.1 What does the insurance principle of subrogation, focuses?
After the insured is compensated for the loss due to damage to property insured, then the right of ownership of such property passes to the insurer
Q.2 What is an important challenge for insurance firms for manual process?
There is a huge amount of unstructured data
Q.3 What does KPI expands to ?
KPI expands to key performance indicator
Q.4 What does justice as ethical principle aims for?
It aims for ethical decisions should be consistent with the ethical theory
Q.5 How many types of health insurance claims are raised?
There are 2 types of health insurance claims raised.
Q.6 Which document is needed for claim settlement for marine insurance ?
Following documents are needed for claim settlement in marine insurance.
1. Bill of Lading
2. commercial Invoice
3. packing list
Q.7 What are the many types of insurance protection?
There are two types of insurance policies: a) General or Non-life Insurance b) Life Insurance
Q.8 What exactly do you mean when you say "insurance coverage"?
When an individual purchases an insurance policy, the insured will be protected by the insurance company for a set amount for themselves or the items for which he purchased the policy, for which he will pay premiums to the insurance company. In the event of damage or claims, the insurance company will compensate the insured according to their "insurance coverage."
Q.9 What exactly is a premium?
It is the money due to the insurance company for a contract of insurance. It is the amount that a person pays to the insurance company on a monthly, quarterly, or annual basis, depending on their plan, in exchange for the coverage they have received.
Q.10 What do the terms "insurer" and "insured" mean?
The insured is the person who is covered by the policy, and the insurer is the company that provides coverage to the insured.
Q.11 Who is the intended recipient?
The beneficiary is the person you've designated to receive the insured amount in the event of your death.
Q.12 What is an insurance policy's contestable period?
The insurance company has the right to investigate the policy and decide whether or not to pay the insured throughout the ‘contestable period,' which is normally 1 or 2 years.
Q.13 What's the difference between a revocable and an irrevocable beneficiary?
The term "revocable beneficiary" refers to the policyholder's ability to change the named beneficiary's name without the approval of the named beneficiary. In the case of an irrevocable beneficiary, the policyholder must obtain the beneficiary's approval before changing the beneficiary's name.
Q.14 What exactly is a no-claim bonus?
A no-claim bonus is a benefit given to those who have not made a claim on their insurance in the previous year of coverage. This will result in a lesser premium the next year.
Q.15 What exactly do you mean when you say 'Loss Payee'?
The loss payee is the person or organisation (Bank) that gets the insurance payment in the event that your property or vehicle is damaged or destroyed. It is a legal term that refers to the investment of other parties or a bank that you own. For example, suppose you have a car that is financed and covered by insurance. Now you've been in an accident and your car is totaled (meaning completely damaged beyond repair). In this scenario, your bank owes you money, and when you claim the insurance, the insurance company will send the money directly to the bank or individual to whom you owe money. The bank is the loss payee in this case.
Q.16 What exactly do you mean when you say 'deductible'?
Deductible is one of various types of clauses used by insurance companies to set a payment threshold for health or travel insurance policies. A deductible is a set amount that you must pay out of pocket when filing an insurance claim. For example, if your deductible is $500 and your insurance coverage is $2000, you will be responsible for $500 and the insurance company will cover the remaining $1500.
Q.17 What is the definition of co-insurance?
Typically, the word "co-insurance" refers to health insurance firms. After paying the deductible or co-payment, you split the coverage with the insurance company as a proportion of the policy value. It refers to how your insurance coverage is split between you and the insurance company; typically, the split is 80/20, with you paying 20% and the insurance company covering the rest. For example, supposing you have a $200 health insurance claim; according to the policy, you must pay a deductible of $100; after paying the deductible, the remaining amount is $100; now you have a co-insurance of 80/20 percent. As a result, you will pay $20 out of your own pocket for a total of $100, with the remaining $80 covered by co-insurance (meaning the insurance company).
Q.18 What exactly do you mean when you say "Annuity"?
An annuity is the word for the amount paid by the insurance company to the insured on a regular basis after a set length of time. The payment can be made on a monthly or quarterly basis, and it is frequently used to augment income after retirement.
Q.19 What is the Value of Surrender?
Surrender Value is the amount you will receive if you cease paying your premium and withdraw the entire sum. When you remove the money, the policy expires, and the insured loses all of the benefits.
Q.20 What is the term "Paid Value"?
When the insured quits paying the premium but does not remove the money, the paid value is something. When the insured stops paying the premiums, the insurance company's total assured is lowered accordingly. The money will be given to you at the end of the period.
Q.21 Is it a good idea to replace the policy with a new one?
You can replace your policy if you haven't had it for a long time. However, in most cases, it is not recommended because you will lose all of the benefits of your previous insurance and your premium will rise as you become older. In addition, the two-year contestability period will begin all over again.
Q.22 How can I make a claim on my insurance?
To make a claim on your policy, fill out the claim form and contact the financial advisor from whom you purchased it. You must submit all essential paperwork to your insurance carrier, including the original payment receipt. If everything goes smoothly, you will be paid within seven days after claiming the policy.
Q.23 What happens if you don't pay your premiums on time?
If the insured fails to pay the premium by the due date, the insurance company usually grants them a grace period of 10-15 days. In addition, if you do not pay a premium, your coverage will lapse. You can resurrect your insurance by paying the unpaid premium, plus interest, starting from the date the policy became lapsed. Each insurance company has its own set of rules for restarting a policy. However, if your policy has been in effect for a longer period of time, such as more than two or three years, and you fail to pay a premium, the insurance company will deduct the premium amount from your collected assets, especially if you have permanent life insurance. This will continue until a fund becomes available, at which point your coverage will be cancelled.
Q.24 Is paying the premium through an Insurance Agent safe?
It is safe to pay your premiums through your agent as long as you write checks in the name of the insurance company and keep track of any receipts.
Q.25 Is it feasible to get a complete refund if you cancel a new insurance during the free look period?
A ‘Free Look Period' is a period of time during which the insured can cancel their freshly purchased insurance within a certain time frame from the date of issue without incurring any fines or surrender charges. Yes, you can collect the whole payment within the free look time; you can cancel your new policy in 15 days by returning it to the life insurance firm after receiving all of the policy documentation.
Q.26 What is the distinction between participating and non-participating policies?
A participating policy is one in which the insurance company's profit or benefits are shared with the insured in the form of a dividend or reversionary bonuses. The non-participating policy, on the other hand, does not split its profits with the insured.
Q.27 Is it possible to limit premium payments to a period of time less than the policy's duration?
Certain insurance companies provide a Limited Premium Payment option, in which you can pay the premium over three, five, seven, or ten years, depending on your income, and still be covered for the duration of the policy.
Q.28 Is it possible for a beneficiary to make a claim on the policy if the insured person has been absent for several years?
If the beneficiary receives a court statement stating that the insured individual is absent or legally deceased, it is permissible to file a claim (disappeared for more than 7 years).
Q.29 Can a person have two insurance policies and claim on both?
Yes, a person can have two insurance and claim on both of them.
Q.30 What does the phrase 'Indemnity' imply?
The term "indemnity" is used in insurance to pay the loss or damage claimed by a third party. For example, the gym's owner carries indemnity insurance to recompense its customers in the event of damage or accident, as well as to avoid financial loss as a result of a lawsuit.
Q.31 What do you mean when you say "Double Indemnity?"
Double Indemnity' is a provision provided by some insurance companies under which they are obligated to pay double the face amount in the event of accidental death or murder, according to their policy. This sort of policy excludes suicide and death caused by the insured person's gross carelessness. For example, a person who dies through natural reasons such as heart disease or cancer, assassination or plot by a beneficiary, or death as a result of carelessness.
Q.32 What is the definition of subrogation?
The process of pursuing reimbursement from the responsible party for a claim that they had previously paid is known as subrogation. If, for example, your car is destroyed in an accident and you have auto insurance, the insurance company will compensate you. However, if the insurance company discovers that the accident was caused by the fault of another party, they would seek reimbursement from the other party, a process known as "subrogation."
Q.33 What exactly do you mean when you say "monetary value"?
The cash amount offered to the policy holder when the policy is cancelled, with a portion of the premium paid going into a savings plan. It's also known as the surrender value. This is a common term for a life insurance contract.
Q.34 When the policy is entirely paid up, what happens to the cash value?
The firm intends to use the cash value to pay your premiums until you die once the policy is fully paid off. If you withdraw the cash value, the insurer will either force you to pay the premium or cut the death benefit amount so that the remaining cash value can sustain you.
Q.35 What is the insurance term "elimination period"?
The elimination period is the amount of time you must wait before receiving payments under disability income insurance or loss of income insurance. In other words, it is the time between the onset of the injury and the payment of benefits. The lower the premium, the longer the Elimination period is, and vice versa.
Q.36 What does it mean to have a "Endowment Policy"?
An endowment policy is a type of insurance that combines saving with risk protection. This type of coverage is designed to help you build wealth while also protecting your life. In this sort of coverage, the insured pays a set premium for a set length of time. And, in the event of death, the money will be paid to the beneficiary; however, if you live longer than the policy term, you will get the sum assured plus any accumulated bonus.
Q.37 What does it imply when a corporation states there will be no physical examination?
Such an insurance firm that states, "No physical exam," allows policyholders the option of purchasing a policy while avoiding the physical exam that is required by several life insurance companies. Typically, such an insurance firm is more expensive, and the insured must pay a larger policy premium.
Q.38 What is the definition of "group life" insurance?
A single policy that covers an entire organisation is referred to as "group life insurance." As an individual policy holder, it may cost more than a group policy because it is taken by an employer for the larger business to protect their employees.
Q.39 Does the recipient of a life insurance policy have to pay taxes on the proceeds?
In most cases, the benefits of a life insurance policy are tax-free, and the beneficiary is not responsible for paying any taxes following the policyholder's death. However, if you change your beneficiary for monetary benefit or other reasons, the beneficiary must pay tax.
Q.40 Is it possible to convert a portion of a term life insurance policy to a permanent policy?
Yes, as long as you have a convertible life insurance policy, it is feasible to convert. However, there is a deadline for converting term life insurance to permanent life insurance that must be met. In addition, as soon as you convert your coverage, your premium will increase.
Q.41 What is third-party insurance, and how does it work?
Third-party insurance is an insurance policy that covers harm caused by another person or entity. The insured is the first party in this sort of insurance, the insurance company is the second party, and the damage caused by another is referred to as the third party. This form of insurance policy is obtained for vehicles so that they can make a claim in the event of an accident.
Q.42 What does Personal Accident Insurance entail? Is it applicable all around the world?
Personal Accident Insurance is for your personal vehicle and covers you or your family in the event of a fatal accident, excluding the driver. The majority of insurance firms provide coverage all throughout the world.
Q.43 What exactly is 'gap insurance'?
Guaranteed Auto Protection is another name for GAP insurance. It compensates for the gap between the vehicle's actual cash worth and the remaining debt on a loan. The sum of GAP insurance is usually paid up advance.
Q.44 What's the difference between a "single limit liability" policy and a "split liability" policy?
‘Single limit liability coverage' protects a single person from bodily injury and property damage. For example, if an accident occurs, just one person will be covered, regardless of how many others are injured. Split liability coverage, on the other hand, covers each person separately.
Q.45 What do the terms "collision coverage" and "comprehensive coverage" mean in the context of auto insurance?
When you have a collision with another object or vehicle, collision coverage is provided, whereas comprehensive coverage is provided when your automobile is not in use.
Q.46 What does the term ‘PLPD' insurance mean?
Personal liability and property damage is abbreviated as PLPD. When an individual causes injury to others in an accident, personal culpability is covered, whereas property damage is covered when any property is damaged. In both cases, the injured victim or a third party will seek compensation from the offender's insurance company.
Q.47 Since claims managers often are in charge of resolving customer complaints. Share a situation where you satisfied an unhappy customer?
While working as a claims representative, we had a customer who was very unhappy because her automobile accident was not being handled quickly. She called up daily and complained. At that point I decided to be proactive and work harder to escalate her claim along. After which I called her daily and give her a progress report. This extra effort I made helped resolve her issue early and make her happy.
Q.48 Let us suppose you are in charge of making sure the other claims representatives are productive. What will you do in this case?
It is extremely crucial to ensure that the claims representatives know what is expected of them. When the candidate knows the expectations they are more likely to be productive and work towards meeting the requirements of their job. Sample Answer - In order to ensure efficiency I would meet with each representative regularly. I would also follow up constantly through email. If some representatives is not able to meet expectations, then I will help them perform better with required training.
Q.49 By what means will you ensure that our company avoids fraudulent claims?
Sample Answer - As a claims manager I would try ensure to spend ample time researching and evaluating each claim to ensure it 's validity. Also I would set certain standards that a normal claim falls under. This helps to make it easier to identify claims that have the potential to be fraudulent. In addition I would ask the representatives to be more detailed oriented when they are evaluating the claims.
Q.50 Since claims managers are required to spend some of their time on the phone. What are the skills needed according to you that will help in this role?
As a part of the claims process phone conversations are considered to be very challenging as there are a lot of people who a claims manager has to communicate with over the phone. As a claims manager it is therefore important to speak slowly and clearly so that people can hear and response clearly. The key to have a successful conversation is to be patient and positive as it allows to please the person and minimize the likelihood of a stressful conversation.
Q.51 As a claims manager you are required to coordinate with insurance agents, brokers, loss adjusters, customers, and other people to process claims. How will do you ensure everyone receives full attention?
As a claims manager you must be an effective time manager as well as should be good at scheduling tasks and prioritizing what needs to get done. These skill help as to attend the needs of the other people we work with. Sample Answer - I stay organized and have the ability to find the time to fit people in when they need assistance. I am also flexible and understanding, in case if there is a need to adjust schedule to meet their needs,
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