Claims Adjudicator Interview Questions and Answers

Claim adjudication is the process of reviewing and evaluating insurance claims to determine their validity and payment amount.

• Claims adjudication involves reviewing and verifying the information provided in a claim

• It also involves determining the coverage and benefits available under the policy

• The adjudicator then decides whether to approve or deny the claim and calculates the payment amount

• Examples of claims that may require adjudication include medical, auto, and property d...read more

COB stands for Coordination of Benefits, pr stands for Provider, and EOB stands for Explanation of Benefits.

• COB is a process used by insurance companies to determine which insurance plan is responsible for paying for a particular medical claim.

• PR refers to the healthcare provider who rendered the medical service.

• EOB is a document sent by the insurance company to the policyholder explaining how a medical claim was processed and what portion of the cost is covered by insurance....read more

Healthcare is the maintenance or improvement of health through the prevention, diagnosis, treatment, and recovery of illness and injury.

• Healthcare involves a wide range of services including medical, dental, mental health, and pharmaceutical care.

• It includes preventive measures such as vaccinations, screenings, and health education.

• Healthcare providers can include doctors, nurses, therapists, pharmacists, and other professionals.

• Healthcare can be provided in various settings ...read more

NTT Data is a global IT services company providing consulting, technology, and outsourcing services.

• NTT Data is a subsidiary of Nippon Telegraph and Telephone Corporation.

• It offers services in areas such as healthcare, finance, and public sector.

• NTT Data has a presence in over 50 countries worldwide.

• The company has expertise in data analytics, cloud services, and digital transformation.

Deductible is the amount of money that the insured must pay out of pocket before the insurance company starts paying for covered expenses.

• Deductible is a fixed amount set by the insurance company that the insured must pay before the insurance coverage kicks in.

• It is typically an annual amount that resets each year.

• Once the deductible is met, the insurance company will start covering a portion or all of the remaining costs.

• Higher deductibles usually result in lower monthly pre...read more