Senior Claims Associate Interview Questions and Answers

Authorization and COB denial handling for primary and secondary payers

• Authorization denial can occur when a service or procedure is not covered by the insurance plan

• COB denial happens when the primary payer has not paid the full amount and the secondary payer is responsible for the remaining balance

• To handle authorization denial, I would review the insurance policy and communicate with the provider to determine if an appeal is necessary

• For COB denial, I would verify the prima...read more

ABN is a form used to inform patients of potential non-covered services. Hpcs is a coding system for healthcare procedures. ICD 10 is a coding system for medical diagnoses.

• ABN stands for Advance Beneficiary Notice. It is used to inform Medicare patients of potential non-covered services and the cost they may incur.

• Hpcs stands for Healthcare Common Procedure Coding System. It is used to code healthcare procedures and services for billing purposes.

• ICD 10 stands for Internationa...read more

Bundling refers to combining multiple products or services into a single package, while inclusive means everything is included in a single price.

• Bundling involves offering a discount when multiple products or services are purchased together

• Inclusive pricing means that all features or services are included in a single price

• Bundling is common in industries such as telecommunications and software

• Inclusive pricing is often used in the hospitality industry, where guests pay a sing...read more

Claim process is the procedure followed by an insurance company to investigate, evaluate, and settle a claim.

• The claimant reports the incident to the insurance company

• The insurance company assigns an adjuster to investigate the claim

• The adjuster evaluates the damages and determines the coverage

• The insurance company issues a payment to the claimant if the claim is approved

• The claimant may appeal the decision if they disagree with the settlement

Claim processing is the procedure of evaluating and settling insurance claims.

• It involves verifying the claimant's eligibility for coverage

• Reviewing the claim to determine if it meets the policy's terms and conditions

• Investigating the circumstances surrounding the claim

• Determining the appropriate amount of compensation to be paid

• Communicating with the claimant and other parties involved in the claim

• Issuing payment to the claimant

• Maintaining accurate records of the claim and i...read more

Insurance is a financial protection against potential losses or damages.

• Insurance is a contract between an individual or organization and an insurance company.

• The individual or organization pays a premium in exchange for coverage against specific risks.

• In case of a covered loss or damage, the insurance company compensates the policyholder.

• Types of insurance include health, auto, home, life, and business insurance.

• Insurance helps individuals and organizations manage financial ...read more

Auth denial is the rejection of a request for medical treatment or service by an insurance company.

• Auth denial occurs when an insurance company determines that a requested medical treatment or service is not covered under the patient's policy.

• This can happen for a variety of reasons, such as the treatment being considered experimental or not medically necessary.

• Auth denial can be appealed by the patient or their healthcare provider.

• Examples of auth denial include a request fo...read more