claim approver Interview Questions and Answers

1. What is your experience with claim processing?

   • Answer: I have [Number] years of experience in claim processing, handling [Volume] claims annually. My experience includes [Specific types of claims processed, e.g., medical, dental, auto]. I am proficient in [Relevant software/systems used].

2. How familiar are you with different types of claims?

   • Answer: I am familiar with [List types of claims, e.g., inpatient, outpatient, professional, pharmacy, dental]. I understand the specific documentation and coding requirements for each type.

3. Describe your experience with claim adjudication.

   • Answer: I have extensive experience in claim adjudication, including reviewing claims for accuracy, completeness, and compliance with payer guidelines. I am skilled in identifying and resolving discrepancies and applying appropriate payment methodologies.

4. How do you handle complex or unusual claims?

   • Answer: I approach complex claims methodically, starting with a thorough review of the documentation. I utilize available resources, such as medical guidelines and payer manuals, and consult with colleagues or supervisors when necessary. I prioritize accuracy and fairness in my decisions.

5. What is your understanding of medical coding and billing?

   • Answer: I understand the principles of ICD and CPT coding. I can identify coding errors and ensure that claims are accurately coded to reflect the services provided.

6. How do you ensure compliance with regulatory requirements?

   • Answer: I stay updated on all relevant regulations, including HIPAA, and ensure all claims are processed in compliance. I maintain detailed records and follow established procedures.

7. How do you prioritize claims for processing?

   • Answer: I prioritize claims based on urgency, such as time-sensitive treatments or appeals, and payer requirements. I also consider the complexity of the claim.

8. How do you handle claim denials?

   • Answer: I investigate the reason for denial, correct any errors, and resubmit the claim with the necessary documentation. If the denial is upheld, I explain the decision to the provider or patient.

9. What software and systems are you proficient in?

   • Answer: I am proficient in [List software/systems, e.g., Facets, Epic, claims processing software].

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