Claims Manager

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10+ Claims Manager Interview Questions and Answers

Updated 21 Jan 2025

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Q1. What do you know about medical insurance?

Ans.

Medical insurance is a type of coverage that pays for medical and surgical expenses incurred by the insured.

  • Medical insurance provides financial protection against the cost of medical treatments and procedures.

  • It helps individuals and families afford healthcare services, including doctor visits, hospital stays, and prescription medications.

  • Insurance companies negotiate rates with healthcare providers to ensure discounted prices for policyholders.

  • Medical insurance plans often ...read more

Q2. How to prepare SOP for marine claims?

Ans.

To prepare an SOP for marine claims, follow these steps:

  • Identify the key steps involved in processing marine claims

  • Define the roles and responsibilities of each team member involved in the claims process

  • Establish guidelines for documentation and record-keeping

  • Outline the procedures for investigating and assessing claims

  • Specify the criteria for approving or denying claims

  • Include instructions for communicating with clients, insurers, and other stakeholders

  • Ensure compliance with...read more

Q3. Why there is separate study for Automobile if Mechanical have?

Ans.

Automobile study focuses on specific aspects of vehicles, while Mechanical engineering covers broader topics.

  • Automobile study delves into topics like automotive design, manufacturing, and maintenance

  • Mechanical engineering covers a wide range of topics including thermodynamics, fluid mechanics, and materials science

  • Separate study for Automobile allows for specialized knowledge and skills in the automotive industry

  • Both fields complement each other in understanding and improving...read more

Q4. Discharge summery and its uses in claims .

Ans.

Discharge summary is a medical document that outlines a patient's hospital stay and treatment plan upon discharge.

  • Discharge summary is a crucial document for claims processing as it provides a detailed account of the patient's medical history, diagnosis, treatment, and follow-up care.

  • It helps claims managers to verify the medical necessity of the treatment provided and ensure that the billed services are appropriate and reasonable.

  • Discharge summary also helps claims managers ...read more

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Q5. What is the third party administrator

Ans.

A third party administrator is a company that provides administrative services for insurance claims on behalf of an insurance company.

  • Third party administrators handle the processing and settlement of insurance claims.

  • They may also handle other administrative tasks such as policy administration and customer service.

  • Third party administrators are independent of the insurance company and act as a middleman between the insurance company and the insured party.

  • They help ensure eff...read more

Q6. How will you know the fraud cases

Ans.

Fraud cases can be identified through various means.

  • Analyzing patterns and inconsistencies in claims data

  • Investigating suspicious claims and claimants

  • Collaborating with law enforcement and other agencies

  • Using data analytics and predictive modeling

  • Staying up-to-date on industry trends and fraud schemes

  • Conducting regular audits and reviews

  • Training staff on fraud detection and prevention

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Q7. Documents required for claim process

Ans.

Documents required for claim process

  • Proof of loss or damage

  • Completed claim form

  • Original receipts or invoices

  • Police report (if applicable)

  • Medical records (if medical claim)

  • Photographs or videos of the incident

  • Witness statements (if available)

  • Any other supporting documents

Q8. What is automobile Engineer?

Ans.

An automobile engineer is a professional who designs, develops, and tests vehicles and their components.

  • Automobile engineers work on designing and developing various vehicle systems such as engines, transmissions, and suspension.

  • They also conduct tests to ensure the safety and performance of vehicles.

  • Automobile engineers may specialize in areas such as aerodynamics, materials, or electronics.

  • Examples of automobile engineers include those working at car manufacturers like Ford...read more

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Q9. Steps of claim process

Ans.

The claim process involves several steps to ensure accurate and timely resolution.

  • 1. Claim submission: The policyholder submits a claim to the insurance company, providing all necessary documentation.

  • 2. Claim review: The insurance company reviews the claim to determine its validity and coverage.

  • 3. Investigation: If required, the insurance company investigates the claim further, gathering additional information or evidence.

  • 4. Claim assessment: The insurance company assesses th...read more

Q10. how to use vlookup

Ans.

VLOOKUP is a function in Excel used to search for a value in a table and return a corresponding value from another column.

  • VLOOKUP stands for vertical lookup.

  • It is commonly used to find data in large datasets or tables.

  • The function requires four arguments: lookup value, table array, column index number, and range lookup.

  • The lookup value is the value you want to search for.

  • The table array is the range of cells that contains the data.

  • The column index number is the column from wh...read more

Q11. Need of job and switch

Ans.

I am looking for a new challenge and growth opportunities in my career.

  • I am seeking a job that aligns with my career goals and aspirations.

  • I am interested in exploring new industries and expanding my skill set.

  • I am motivated to take on new challenges and responsibilities.

  • I am looking for a company that values employee development and growth.

  • I am excited about the opportunity to make a positive impact in a new role.

Q12. PROCESS OF CASHLESS

Ans.

Cashless process allows policyholders to avail medical treatment without paying upfront.

  • Policyholder selects a network hospital for treatment

  • Hospital sends pre-authorization request to insurance company

  • Insurance company reviews request and approves cashless treatment

  • Policyholder receives treatment without paying upfront

  • Insurance company settles the bill directly with the hospital

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