Top 20 Interview Questions & Answers for Claims Associate Roles – 2025

Applying for a role as a claims associate? This guide provides a list of essential questions and answers that will help you showcase your knowledge of insurance claims processing, customer service skills, and ability to work efficiently in a fast-paced environment. Whether you’re applying for a position in property, casualty, or health insurance, these questions cover all key areas of the job.

General Questions

• 1. Tell me about your previous experience in handling insurance claims.
  A: In my previous role, I worked as a claims representative for a major insurance company, where I handled a high volume of property and casualty claims. I also have experience working as a claims assistant, where I assisted senior claims associates with processing and reviewing claims.
• 2. How do you handle difficult or irate customers?
  A: I believe in remaining calm and professional, actively listening to the customer's concerns, and empathizing with their situation. I also strive to find a solution that satisfies the customer and meets the company's policies and procedures.
• 3. Can you give an example of a time when you had to handle a complex insurance claim?
  A: At my previous job, I had to handle a complex health insurance claim involving a dispute over treatment costs. I carefully reviewed the policy and medical records, communicated with the healthcare provider and the customer, and was able to reach a resolution that satisfied both parties.
• 4. How do you prioritize and manage your workload?
  A: I prioritize my workload by setting deadlines and creating a to-do list. I also communicate with my supervisor about any urgent tasks and ask for their guidance in managing my workload. I always strive to work efficiently and meet deadlines.
• 5. In your opinion, what qualities are essential for a successful claims associate?
  A: In my experience, a successful claims associate should have excellent communication and customer service skills, strong attention to detail, and the ability to work efficiently in a fast-paced environment. They should also be knowledgeable about insurance policies, laws, and regulations, and have strong problem-solving abilities.

Behavioral Questions

• 6. Can you tell me about a difficult situation you encountered while handling insurance claims, and how you resolved it?
  A: In my previous job, I received a large volume of claims following a natural disaster. I was under a lot of pressure to process them quickly and accurately. I prioritized my workload, asked for help when needed, and worked overtime to meet the deadlines. As a result, we were able to process all claims efficiently and provide relief to our customers.
• 7. How do you handle a situation where a claim appears to be fraudulent?
  A: I understand that insurance fraud is a serious issue, and as a claims associate, it is my responsibility to identify and prevent it. If I suspect a claim is fraudulent, I carefully investigate the details and evidence and communicate with my supervisor and the appropriate authorities to take appropriate action.
• 8. Tell me about a time when you had to handle a dissatisfied customer, and how you turned the situation around.
  A: In my previous role, a customer was dissatisfied with the outcome of their claim and refused to accept our decision. I listened to their concerns, reassured them that we followed the policy and regulations, and provided them with additional information and options for further action. By the end of the call, the customer was satisfied and even thanked me for my help.
• 9. Describe a situation where you had to handle a confidential claim, and how you maintained confidentiality.
  A: In my previous role, I received a sensitive claim involving medical information. I made sure to handle the information with care, only discussing it with necessary parties and keeping it secured. I also followed company policies and procedures regarding confidentiality.
• 10. How do you stay organized and manage your time to ensure all claims are processed efficiently?
  A: I utilize tools like time-tracking software and a task management system to stay organized and prioritize my workload. I also make sure to communicate with my team and work together to meet deadlines and achieve our goals.

Situational Questions

• 11. How would you handle a situation where a customer's claim is denied due to insufficient coverage?
  A: I would first review the insurance policy and explain to the customer why their claim was denied. I would also offer to review their policy and see if there are any other options available to them, such as additional coverage or appeal options.
• 12. What would you do if a customer's claim appears to be missing necessary information?
  A: I would reach out to the customer and request the missing information, giving them a clear deadline and explaining the importance of the information in processing their claim. I would also offer any assistance they may need in gathering the required information.
• 13. How would you handle a situation where a customer's claim is taking longer to process than expected?
  A: I would apologize for the delay and offer to investigate the issue and follow up with the customer. I would also make sure to keep the customer updated on the progress of their claim and communicate with my team to see if there are any delays or obstacles that can be resolved.
• 14. How would you handle a situation where a customer's claim is not eligible for reimbursement under their policy?
  A: I would carefully review the insurance policy and explain why their claim is not eligible for reimbursement. If the customer is dissatisfied, I would offer to escalate the issue to a supervisor for further review and discussion.
• 15. What would you do if a customer is not satisfied with the amount of compensation they received for their claim?
  A: I would first listen to the customer's concerns and explanation for why they believe they deserve more compensation. If necessary, I would review the claim and policy with my team to see if there is any room for negotiation or appeal. I would also make sure to explain the reasons for the compensation and provide any additional information or resources to the customer.

Technical Questions

• 16. How does your knowledge of various insurance policies and regulations help you in processing claims?
  A: My knowledge of insurance policies and regulations allows me to efficiently review and assess claims, ensuring they meet the coverage requirements and comply with state and federal laws. It also helps me guide customers and provide them with accurate information about their claims.
• 17. Can you explain the claims process for a property insurance policy?
  A: The first step is to document the damage or loss by gathering evidence, such as photographs and receipts. I would then review the policy to determine the coverage and file the claim, including the necessary information and documentation. Finally, I would evaluate the claim and provide a decision to the customer.
• 18. How do you handle medical records and information in a health insurance claim?
  A: I handle medical records and information with strict confidentiality and only share them with necessary parties, such as healthcare providers and insurance adjusters. I also make sure to follow HIPAA regulations and company policies to ensure the security and integrity of the medical information.
• 19. Can you explain the claims process for a liability insurance policy?
  A: The claims process may vary depending on the specifics of the situation, but generally, it involves gathering information and evidence, assessing the damages or injuries, and communicating with involved parties. I would also review the insurance policy to determine the coverage, and if necessary, negotiate or settle the claim.
• 20. How do you stay updated with industry changes and advancements in claims processing?
  A: I attend industry conferences and workshops, read industry publications, and participate in training and certification programs offered by my company. I also make sure to stay current with state and federal laws and regulations related to insurance claims.