Top 20 Interview Questions & Answers for Claims Manager – 2025

Preparing for a claims manager job interview? This guide provides a list of essential questions and answers that will help you showcase your leadership abilities, problem-solving skills, and knowledge of the claims management industry. Whether you’re applying for a role in the insurance, healthcare, or legal industry, these questions cover all key areas of the job.

General Questions

• 1. Tell us about your experience as a claims manager.
  As a claims manager, I have over 10 years of experience handling a variety of insurance claims including property, casualty, and liability. During this time, I have successfully managed a team of claims handlers, developed and implemented efficient claims processes, and maintained a high level of customer satisfaction.
• 2. How do you prioritize and manage your workload?
  I prioritize my workload by first assessing the urgency and complexity of each claim. I then assign tasks to my team accordingly, ensuring that the most critical tasks are completed first. To manage my workload, I use project management software and regularly review my team's progress to identify any potential bottlenecks or issues.
• 3. How do you handle disputes or difficult customers?
  I approach disputes or difficult customers by first actively listening to their concerns and understanding the root of the issue. I remain calm and professional, ensuring that I show empathy and provide clear and transparent communication. I involve relevant parties and work towards a mutually beneficial resolution.
• 4. How do you stay updated with industry regulations and changes?
  I stay updated with industry regulations and changes by regularly attending training and conferences, networking with industry professionals, and following news and updates from relevant governing bodies. I also take advantage of online resources and actively participate in online forums and groups to stay informed.
• 5. How do you handle sensitive or confidential information?
  As a claims manager, I understand the importance of handling sensitive or confidential information with the utmost care and professionalism. I have a strict system in place for storing and accessing confidential information, and I regularly review and update this system to ensure compliance with industry regulations and company policies.

Technical Skills & Experience

• 6. What is your experience with claims management software?
  I have extensive experience working with various claims management software, including ClaimZone and Guidewire. I have also been involved in the implementation of new software and have trained my team on its use. I am always eager to learn new systems and adapt to new processes.
• 7. How do you handle fraudulent or suspicious claims?
  When handling potentially fraudulent or suspicious claims, I conduct thorough investigations and gather as much evidence as possible. I also involve relevant parties, such as law enforcement or loss prevention teams, when necessary. In my experience, staying diligent and following proper procedures is key to successfully handling these types of claims.
• 8. How do you ensure accuracy and consistency in claims processing?
  To ensure accuracy and consistency in claims processing, I have implemented strict quality control measures, such as regular audits and cross-checks. I also provide ongoing training and support to my team to ensure they are knowledgeable and following best practices. Additionally, I regularly review and update processes to improve efficiency and accuracy.
• 9. How do you handle complex and high-value claims?
  Complex and high-value claims require a careful and strategic approach. I first assess the situation and gather all the necessary information, involving relevant parties as needed. I then work closely with my team to develop a plan and timeline for handling the claim in a timely and efficient manner while maintaining a high level of attention to detail.
• 10. How do you handle a large volume of claims?
  To handle a large volume of claims, I prioritize tasks and delegate responsibilities to my team members. I also regularly review and adjust processes to ensure maximum efficiency. I am also open to using technology and automation to streamline processes and increase productivity.

Behavioral Questions

• 11. Can you give an example of a difficult claim you successfully managed?
  In my previous role, I handled a property damage claim that involved multiple parties and complex coverage issues. I organized a team to thoroughly investigate the claim, worked closely with legal counsel, and effectively communicated with all parties involved to reach a fair settlement. The case was resolved within the expected timeframe, and both the client and company were satisfied with the outcome.
• 12. Tell us about a time when you had to make a tough decision quickly.
  As a claims manager, I have encountered several situations where I had to make tough decisions quickly. One example was when one of my team members was out sick, and we received a large volume of claims. I had to quickly assign tasks, rework processes, and communicate updated timelines to ensure that all claims were processed on time. My quick decision-making and ability to adapt to unexpected challenges ensured that the claims department continued to function smoothly.
• 13. How do you prioritize customer satisfaction while also managing company resources?
  I believe that customer satisfaction and company resources are equally important and must be balanced. I prioritize customer satisfaction by providing timely and transparent communication, actively listening to their concerns, and working towards a fair resolution. At the same time, I also ensure that company resources are utilized efficiently by monitoring expenses and reviewing processes to identify areas for improvement.
• 14. Tell us about a time when you had to handle a difficult customer complaint.
  In my previous role, I received a complaint from an unhappy client who had experienced a significant delay in receiving their insurance payout. After investigating the issue, I found that the delay was due to an error made by our external payment processing company. I apologized to the client and worked closely with the payment company to resolve the issue and ensure that the client received their payment promptly. The client was appreciative of my prompt response and resolution of the problem.
• 15. How do you handle conflicts within your team?
  I believe in open and honest communication and addressing conflicts within the team directly and professionally. I listen to both sides and strive to find a resolution that is fair and beneficial to everyone involved. I also encourage team members to discuss any conflicts with me or HR if they feel uncomfortable addressing the issue directly.

Situational Questions

• 16. How would you handle a situation where a claim was denied due to lack of coverage?
  If a claim was denied due to lack of coverage, I would first thoroughly review the policy and the specifics of the claim to ensure accuracy. Then, I would communicate with the client to explain the denial and provide options for next steps, such as appealing the decision or exploring other coverage options. I would also work with the underwriting team to ensure that any potential gaps in coverage are addressed for future clients.
• 17. How would you handle a situation where a client's claim was taking longer to process than expected?
  If a client's claim was taking longer to process than expected, I would first communicate with the client to update them on the status of their claim and provide an estimated timeline for completion. I would also review the process to identify any potential delays and make necessary adjustments to ensure the claim is processed as quickly as possible without compromising accuracy. I would also involve relevant parties, such as adjusters or legal counsel, if necessary.
• 18. How would you handle a situation where a team member consistently misses deadlines?
  If a team member consistently misses deadlines, I would first address the issue privately and discuss any potential challenges or issues they may be facing. Then, I would work with the team member to develop an action plan to address the issue, which could include providing extra support, adjusting deadlines, or implementing a performance improvement plan. I would also regularly review progress and provide ongoing feedback to ensure improvement.
• 19. How would you handle a situation where a client was unhappy with their claim settlement?
  If a client was unhappy with their claim settlement, I would first listen to their concerns and gather all the necessary information. I would review the claim and the settlement process to ensure accuracy and fairness. If necessary, I would involve relevant parties and work towards finding a resolution that meets both the client's needs and company guidelines.
• 20. How would you handle a situation where a team member was not following proper claims processing procedures?
  If a team member was not following proper claims processing procedures, I would first provide them with additional training and support to address any knowledge gaps. I would also review our processes to identify any confusion or issues that may be leading to non-compliance. If the issue persists, I would have a transparent conversation with the team member to address the issue and provide appropriate consequences as per company policy.