Top 20 Interview Questions & Answers for Medical Claims Examiner - 2025

If you are looking to be a medical claims examiner, it is important to make sure you have a strong understanding of the industry and the skills necessary to succeed. This list of interview questions and answers will help you stand out as a top candidate and demonstrate your proficiency in handling medical claims. Make sure to customize your answers to fit your own experience and expertise.

General Questions

• 1. Tell us about your background and experience in the medical claims industry.
  This helps assess your overall understanding of the industry and your previous experience with medical claims.
• 2. What motivated you to become a medical claims examiner?
  This question evaluates your passion for the job and your reasons for pursuing it.
• 3. What do you find most challenging about being a medical claims examiner?
  Your answer will help us understand any potential weaknesses and areas for improvement.
• 4. How do you prioritize and manage your workload?
  Effective time management is crucial in this role, and this question assesses your ability to handle a high volume of claims.
• 5. What do you know about the latest regulations and laws related to medical claims processing?
  This demonstrates your current knowledge and understanding of the industry and your ability to stay updated on important changes.

Technical Skills & Experience

• 6. What experience do you have with different types of medical claims, such as Medicare, Medicaid, and private insurance claims?
  This assesses your familiarity and proficiency with handling a variety of claim types.
• 7. How do you ensure accuracy and attention to detail when processing medical claims?
  Detail-oriented and accurate work is critical in this role, so this question evaluates your approach to maintaining accuracy.
• 8. Can you walk us through your process when reviewing and adjudicating a medical claim?
  This demonstrates your understanding of the entire claims process and your ability to explain it in an organized manner.
• 9. Share an experience where you had to deal with an especially difficult or complex medical claim. How did you handle it?
  This gauges your problem-solving skills and your ability to handle challenging situations.
• 10. Have you used any electronic claims processing software? If so, which ones?
  Many companies utilize specific software for medical claims processing, so this evaluates your prior experience with relevant tools.

Behavioral Questions

• 11. Describe a time when you had to communicate complex medical information to a non-medical individual. How did you ensure they understood?
  Effective communication is crucial in this role, so this question assesses your ability to communicate technical information in a clear and understandable way.
• 12. Have you ever had to deal with a difficult or angry customer? How did you handle the situation?
  This demonstrates your customer service skills and your ability to handle challenging interactions.
• 13. Share an experience where you had to make a difficult decision, regarding a medical claim. How did you make the decision?
  This evaluates your critical thinking and decision-making skills, as well as your ability to handle tough choices.
• 14. Describe a time when you had to work with a team to process a high volume of medical claims. How did you ensure efficient and accurate processing?
  Teamwork is important in this role, so this question assesses your ability to collaborate with others and manage multiple tasks at once.
• 15. Have you had to handle a delicate or sensitive medical claim? How did you ensure privacy and confidentiality?
  This demonstrates your understanding of HIPAA laws and your respect for patient privacy and confidentiality.

Situational Questions

• 16. You receive a highly urgent medical claim that needs immediate processing. However, you are already swamped with other claims. How do you handle the situation?
  This question evaluates your ability to prioritize and manage a high-pressure situation.
• 17. A patient's medical claim is denied due to a missing document. How would you follow up with the patient and ensure the claim is processed accurately and in a timely manner?
  This assesses your problem-solving skills and your ability to handle roadblocks in the processing of medical claims.
• 18. How do you handle a medical claim that appears to be fraudulent or contains inaccurate information?
  Integrity is crucial in this role, so this question evaluates your approach to handling potential fraud or inaccuracies.
• 19. A coworker is struggling to meet their processing goals. How would you approach the situation?
  This demonstrates your approach to teamwork and your ability to mentor and support others.
• 20. How do you stay organized and manage your workload during a particularly busy period with high volume of claims?
  This assesses your time management and organizational skills, as well as your ability to handle spikes in workload.