100+ Senior Specialist Interview Questions and Answers

Common denials we work on in our role as Sr. Specialist.

• Missing or invalid information

• Lack of medical necessity

• Untimely filing

• Duplicate claim

• Service not covered by plan

• Out of network provider

• Coordination of benefits issue

• Pre-existing condition exclusion

• Non-covered service

• Experimental or investigational service

APT stands for Advanced Persistent Threat. MITRE ATT&CK is a framework that categorizes and describes common attack techniques.

• APT refers to a sophisticated and long-term cyber attack targeting specific organizations or individuals.

• MITRE ATT&CK is a knowledge base that provides information on various attack techniques used by adversaries.

• APT attacks are often carried out by skilled and well-funded threat actors.

• MITRE ATT&CK helps organizations understand and defend against th...read more

Inherent risk is the risk level before any actions are taken to mitigate it, while residual risk is the risk level after mitigation efforts.

• Inherent risk is the risk level that exists before any actions are taken to mitigate it

• Residual risk is the risk level that remains after mitigation efforts have been implemented

• Inherent risk is inherent to the activity or situation, while residual risk is what is left over after controls are put in place

• Inherent risk can be assessed base...read more

The task is to count the number of characters in a given string.

• Iterate through each character in the string and increment a counter for each character encountered.

• Consider spaces and special characters as well while counting the characters.

• Example: For the string 'Hello World!', the number of characters would be 12.

OSI layer is a conceptual framework that standardizes the functions of a telecommunication or computing system. DHCP is a network protocol that enables a server to automatically assign an IP address to a computer. DNS is a system that translates domain names to IP addresses.

• OSI layer is a conceptual model that characterizes and standardizes the functions of a telecommunication or computing system.

• DHCP (Dynamic Host Configuration Protocol) is a network protocol that enables a ...read more

Future and forward are both financial contracts, but differ in terms of settlement date and delivery of the underlying asset.

• A forward contract is an agreement between two parties to buy or sell an asset at a predetermined price and date in the future.

• A futures contract is similar to a forward contract, but is traded on an exchange and has standardized terms.

• Futures contracts are settled daily, while forward contracts are settled at the end of the contract term.

• Futures contra...read more

SQL queries for multiple questions

• Use SELECT statement to retrieve data from tables

• Use WHERE clause to filter data based on conditions

• Use JOIN clause to combine data from multiple tables

• Use GROUP BY clause to group data based on a column

• Use ORDER BY clause to sort data based on a column

Calculate sum and length of an array with string numeric values.

• Convert string numeric values to integers before calculating sum.

• Use a loop to iterate through the array and calculate sum and length.

• Handle non-numeric values in the array to avoid errors.

• Example: ['5', '10', '15'] should result in sum: 30 and length: 3.

Repartitioning involves changing the number of partitions in a dataset, while coalesce involves reducing the number of partitions without shuffling data.

• Repartitioning increases or decreases the number of partitions in a dataset, which may involve shuffling data across the cluster.

• Coalesce reduces the number of partitions in a dataset without shuffling data, which can improve performance by minimizing data movement.

• Example: Repartitioning a dataset from 4 partitions to 8 part...read more

Stored procedures are precompiled SQL queries stored in a database for reuse.

• Stored procedures are used to encapsulate logic for data manipulation in a database.

• They can accept input parameters and return results.

• Stored procedures can improve performance by reducing network traffic and optimizing query execution.

• Examples include procedures for inserting, updating, or deleting records in a database.

SOLID principles are design principles in object-oriented programming. In Ruby, they help in creating maintainable and scalable code.

• Single Responsibility Principle (SRP) - A class should have only one reason to change.

• Open/Closed Principle (OCP) - Classes should be open for extension but closed for modification.

• Liskov Substitution Principle (LSP) - Objects of a superclass should be replaceable with objects of its subclasses without affecting the program's correctness.

• Interfa...read more

STP, VTP, DTP, VLAN are networking protocols and technologies used in managing and organizing network traffic.

• STP stands for Spanning Tree Protocol and is used to prevent loops in Ethernet networks.

• VTP stands for VLAN Trunking Protocol and is used to manage VLAN configurations across a network.

• DTP stands for Dynamic Trunking Protocol and is used to negotiate trunking between switches.

• VLAN stands for Virtual Local Area Network and is used to logically segment a network into se...read more

SQL aggregate functions perform calculations on a set of values and return a single value.

• Aggregate functions include SUM, AVG, COUNT, MIN, and MAX

• They are used with the SELECT statement to calculate and return a single value from a group of rows

• Examples: SELECT SUM(sales), AVG(price), COUNT(*), MIN(age), MAX(score) FROM table_name

A domain controller is a server that manages network security, user access, and permissions within a Windows domain.

• Manages network security within a Windows domain

• Controls user access and permissions

• Stores user account information and authentication data

• Replicates data to other domain controllers for fault tolerance

• Examples: Active Directory Domain Services (AD DS) in Windows Server

Sales figures in terms of number, top line and bottom line.

• Number of sales refers to the quantity of products sold.

• Top line sales refer to the total revenue generated from sales.

• Bottom line sales refer to the profit made after deducting all expenses.

• It is important to track all three metrics to understand the overall performance of sales.

• For example, a company may have high top line sales but low bottom line sales due to high expenses.

Inclusive denial refers to the act of denying access or opportunities to individuals or groups based on their characteristics or identities.

• Inclusive denial is a form of discrimination that excludes certain individuals or groups from participating in social, economic, or political activities.

• It can occur in various contexts such as employment, education, housing, healthcare, and public services.

• Examples of inclusive denial include refusing to hire someone based on their race,...read more

Blue screen error is a system error that occurs in Windows operating system.

• Also known as Blue Screen of Death (BSOD)

• Occurs when the system encounters a critical error and cannot recover

• Usually caused by hardware or software issues

• Displays a blue screen with error message and system information

• Requires a system restart to fix the issue

Strong analytical skills, problem-solving abilities, communication skills, and technical expertise can help drive business success.

• Analytical skills to interpret data and make informed decisions

• Problem-solving abilities to address challenges and find effective solutions

• Communication skills to collaborate with team members and stakeholders

• Technical expertise to leverage tools and technologies for efficiency

• Examples: proficiency in data analysis software, experience in project ...read more

MSI Packaging is the process of creating an installer package for software applications.

• MSI stands for Microsoft Installer

• It is a file format used for installation, maintenance, and removal of software on Windows operating systems

• MSI packages can be created using tools like InstallShield, WiX, and Advanced Installer

• They can include files, registry entries, shortcuts, and other components needed for the software to run

• MSI packages can be deployed using Group Policy, SCCM, or o...read more

J.E stands for Journal Entry, which is a record of financial transactions in a company's accounting system.

• J.E is used to record all financial transactions in a company's accounting system

• It includes details such as date, accounts involved, amounts, and descriptions

• J.E is used to create financial statements such as the balance sheet and income statement

• It helps in identifying errors and discrepancies in the accounting system

• Example: A company records a sale of $1000. The J.E ...read more

Active Directory is a directory service developed by Microsoft for Windows domain networks.

• Centralized management of network resources

• Authentication and authorization of users and computers

• Organizational units for organizing objects

• Group policies for controlling user settings

• DNS services for locating network resources

Hedging funds is done to reduce the risk of losses in investments.

• Hedging is a risk management strategy used to offset potential losses.

• It involves taking an opposite position in a related asset or security.

• Hedging funds can protect against market volatility and unexpected events.

• Examples include using futures contracts, options, and short selling.

• Hedging can also limit potential gains, but it is a necessary tool for managing risk.

The irrigation regime is determined by factors such as soil type, crop type, climate, and water availability.

• Soil type: Different soil types have different water holding capacities and drainage characteristics, which influence the irrigation regime.

• Crop type: Different crops have different water requirements at different growth stages, which determine the irrigation regime.

• Climate: Factors like temperature, humidity, and rainfall patterns affect the evaporation rate and water...read more

SLA stands for Service Level Agreement, which is a contract between a service provider and a customer that outlines the level of service expected.

• SLA defines the level of service a customer can expect from a service provider

• It outlines the metrics that will be used to measure the service provided

• SLAs are commonly used in IT and telecommunications industries

• Examples of SLA metrics include uptime, response time, and resolution time

Dataframe is a distributed collection of data organized into named columns, while RDD is a distributed collection of data organized into partitions.

• Dataframe is higher level abstraction than RDD in Spark.

• Dataframe is immutable and supports SQL queries, while RDD is mutable and does not support SQL queries.

• Dataframe provides optimization through Catalyst optimizer, while RDD does not have built-in optimization.

• Example: val df = spark.read.json("file.json") // Dataframe, val rd...read more

Adminstudio is a software packaging tool used for creating, testing, and deploying software packages.

• Adminstudio helps in automating the software packaging process

• It ensures that the software is compatible with the target environment

• It also helps in identifying and resolving any potential issues with the software package

• Adminstudio supports various packaging formats such as MSI, App-V, and ThinApp

• It is widely used by IT professionals and software developers for software packa...read more

Pervasive encryption is the practice of encrypting data at every point in its lifecycle.

• Pervasive encryption ensures that data is protected at all times, whether it is at rest or in transit.

• It involves encrypting data at every point in its lifecycle, from creation to deletion.

• Examples of pervasive encryption include encrypting data on a hard drive, encrypting data in transit over a network, and encrypting data in a database.

• Pervasive encryption is becoming increasingly import...read more

Caption is a text that provides a description or explanation for an image or video.

• A caption is typically displayed below or beside the image or video it describes.

• It helps provide context, clarify content, or add additional information.

• Captions are commonly used in social media posts, news articles, and presentations.

• For example, a caption for a photo of a beach could be 'Enjoying a sunny day at the beach.'

Problem management involves identifying, analyzing, and resolving recurring issues to prevent future incidents.

• Identifying root causes of problems

• Implementing solutions to prevent recurrence

• Documenting and tracking problems and resolutions

• Collaborating with other teams to address systemic issues

IT Service Management (ITSM) processes are a set of activities that help organizations design, deliver, manage, and improve IT services.

• ITSM processes include incident management, problem management, change management, service level management, and more.

• These processes help ensure that IT services are aligned with the needs of the business and delivered efficiently.

• For example, incident management involves resolving IT issues quickly to minimize impact on users.

• Change managem...read more

OpenShift is a container platform by Red Hat, while Kubernetes is an open-source container orchestration tool.

• OpenShift is a commercial product by Red Hat that builds on top of Kubernetes for added features and support.

• Kubernetes is an open-source container orchestration tool developed by Google.

• Both OpenShift and Kubernetes are used for managing containerized applications in a clustered environment.

• Kubernetes helps in automating the deployment, scaling, and management of con...read more

CI/CD pipelines automate the process of delivering software updates.

• CI/CD stands for Continuous Integration/Continuous Delivery

• Automates the process of building, testing, and deploying software

• Helps in detecting bugs early in the development process

• Increases the speed of software delivery

• Reduces manual errors and improves overall efficiency

Banned drug combinations are drug combinations that are prohibited due to potential risks or adverse effects.

• Banned drug combinations are combinations of medications that have been deemed unsafe or ineffective.

• These combinations may lead to serious side effects, drug interactions, or reduced efficacy.

• Examples of banned drug combinations include the use of certain antibiotics with specific anticoagulants, or the combination of certain antidepressants with monoamine oxidase inh...read more

CTC as per market varies based on industry, job role, experience and location.

• CTC stands for Cost to Company and includes all the expenses incurred by the company on an employee

• CTC varies based on industry, job role, experience and location

• For example, a software engineer in Bangalore may have a higher CTC compared to a software engineer in a smaller city

• CTC may include components like base salary, bonuses, health insurance, retirement benefits, etc.

Utilize streams to filter and map elements in an array of strings

• Use stream.filter() to filter elements based on a condition

• Use stream.map() to transform elements into a new form

• Example: List filteredList = stringList.stream().filter(s -> s.startsWith("A")).map(String::toUpperCase).collect(Collectors.toList());

OOPS (Object-Oriented Programming) is a programming paradigm based on the concept of objects, which can contain data in the form of fields and code in the form of procedures.

• OOPS focuses on the creation of objects that interact with each other to solve a problem.

• It involves concepts like classes, objects, inheritance, polymorphism, and encapsulation.

• Example: Inheritance allows a class to inherit properties and behavior from another class, promoting code reusability.

The 59 modifier is a coding modifier used in medical billing to indicate a distinct procedural service.

• The 59 modifier is used to identify procedures or services that are separate and distinct from other services performed on the same day.

• It is used to bypass the National Correct Coding Initiative (NCCI) edits and allow separate payment for the additional procedure or service.

• The 59 modifier should only be used when no other more specific modifier is available to accurately d...read more

NCC edits are a set of rules used by insurance companies to determine the appropriateness and accuracy of medical claims.

• NCC edits stand for National Correct Coding edits.

• They are developed by the Centers for Medicare and Medicaid Services (CMS) and used by insurance companies to prevent improper payments.

• NCC edits compare the codes submitted on medical claims to identify any discrepancies or errors.

• These edits help ensure that the services billed are supported by appropriate...read more

The 22 modifier is a billing modifier used in medical coding to indicate that a procedure was discontinued due to extenuating circumstances.

• The 22 modifier is used to report a procedure that required additional time, effort, or complexity beyond the usual

• It is typically used when a surgeon encounters unexpected difficulties during a procedure

• The 22 modifier can result in increased reimbursement for the procedure

• For example, if a surgeon needs to remove a tumor that is larger ...read more

The project architecture is designed to outline the structure, components, and interactions of the system.

• The project architecture includes the high-level design of the system, such as modules, layers, and components.

• It defines how different parts of the system communicate with each other and the overall flow of data.

• Common architectural patterns used are MVC (Model-View-Controller), Microservices, and Serverless.

• Examples of project architecture components include databases, ...read more

Forex, or foreign exchange, is the global marketplace for trading currencies.

• Forex involves buying and selling currencies in order to profit from fluctuations in exchange rates

• It is the largest financial market in the world, with trillions of dollars traded daily

• Major participants in the forex market include banks, financial institutions, governments, and individual traders

• Popular currency pairs traded in forex include EUR/USD, GBP/JPY, and USD/JPY

VPC stands for Virtual Private Cloud, a virtual network dedicated to a user's AWS account.

• VPC allows users to launch AWS resources into a virtual network that they've defined.

• Users can configure their VPC with their own IP address range, subnets, and route tables.

• VPC provides advanced security features such as security groups and network access control lists (ACLs).

A roadmap is a strategic plan that outlines the goals, milestones, and timeline for achieving a specific objective.

• A roadmap helps to visualize the journey towards a goal or objective.

• It typically includes key milestones, tasks, and deadlines.

• Roadmaps are commonly used in project management, product development, and strategic planning.

• Example: A product roadmap outlines the features and enhancements that will be developed over the next year.

SSL handshake is a process where a client and server establish a secure connection.

• SSL handshake is initiated by the client when it connects to a server over HTTPS.

• During the handshake, the client and server exchange information and agree on encryption algorithms and keys.

• The handshake involves multiple steps, including client hello, server hello, certificate exchange, key exchange, and session establishment.

• The client and server authenticate each other's identities using dig...read more

Journal entry for fixed assets involves debiting the fixed asset account and crediting the cash or accounts payable account.

• Debit the fixed asset account for the cost of the asset

• Credit the cash or accounts payable account for the same amount

• Include any additional costs such as installation or transportation in the fixed asset account

• Depreciation expense is recorded separately over the useful life of the asset

The process flow of fixed assets involves acquisition, tracking, depreciation, and disposal of tangible assets.

• Acquisition: Purchasing or acquiring fixed assets such as equipment, machinery, or property.

• Tracking: Recording and monitoring the usage and value of fixed assets over time.

• Depreciation: Calculating and accounting for the decrease in value of fixed assets over their useful life.

• Disposal: Selling, scrapping, or otherwise removing fixed assets from the company's record...read more

A 401k is a retirement savings plan sponsored by an employer that allows employees to save and invest a portion of their paycheck before taxes.

• 401k contributions are typically invested in a variety of mutual funds or other investment options

• Employers may match a portion of the employee's contributions

• Withdrawals from a 401k are typically taxed as ordinary income and may incur penalties if taken before retirement age