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

Preparing for a medical claims processor job interview? This guide provides a list of essential questions and answers that will help you showcase your knowledge, experience, and ability to process complex medical claims accurately and efficiently. Whether you're applying for a role in a hospital, insurance company, or healthcare provider, these questions cover all key areas of the job.

General Questions

• 1. What motivated you to become a medical claims processor?
  As I have always been interested in the healthcare industry and enjoy working with numbers and data, I found that a career as a medical claims processor would allow me to combine my interests and skills. I also appreciate the important role that medical claims processors play in ensuring timely payment for medical services and helping patients receive the care they need.
• 2. How do you stay updated on changes in the healthcare industry?
  I actively follow industry news and attend seminars and conferences to stay informed on any changes or updates in healthcare policies, regulations, and insurance processes. I also have a strong network of colleagues and mentors who I can consult for insights and updates.
• 3. How do you prioritize and organize your workload?
  I prioritize my workload by urgency, complexity, and deadline. I begin each day by reviewing my tasks and creating a list of priorities. Then, as I work through my tasks, I make sure to stay organized by keeping detailed notes, updating spreadsheets, and communicating regularly with my team.
• 4. How do you handle challenging or difficult medical claims?
  When faced with a challenging claim, I first review all relevant documentation and policies to ensure that I understand the situation fully. I then communicate with the insurer and the healthcare provider to gather any necessary information and resolve any discrepancies effectively. If needed, I can also seek guidance or assistance from my supervisor or a more experienced coworker.
• 5. How do you handle tight deadlines and high volumes of work?
  I am used to working in a fast-paced and high-pressure environment, and I have developed strong time management skills to effectively handle tight deadlines and high volumes of work. I prioritize my tasks, work efficiently, and am proactive in seeking support or delegating tasks when necessary.

Technical Skills & Experience

• 6. How do you ensure the accuracy and completeness of medical claims?
  Along with my attention to detail, I have developed a thorough and systematic approach to reviewing and processing medical claims. I follow all relevant guidelines and regulations, double-check all data and calculations, and am always willing to ask for clarification or guidance when needed.
• 7. What is your experience with medical coding and billing?
  I have extensive experience working with medical codes such as CPT, HCPCS, and ICD-10. I am also familiar with billing procedures and have a strong understanding of insurance regulations and policies.
• 8. How do you handle confidential or sensitive patient information?
  I understand the importance of patient confidentiality and am thorough in following all relevant privacy laws and regulations. I am also careful to maintain the security of any sensitive information and have experience working with secure database systems.
• 9. Have you used any specialized medical claims processing software?
  Yes, I have experience working with various medical claims processing software, including Epic, Cerner, and Meditech. I am also proficient in Microsoft Excel and can quickly learn new software as needed.
• 10. Have you ever had to deal with a denied or rejected medical claim?
  Yes, I have encountered denied or rejected claims in the past. In these situations, I carefully review the reasons for the denial or rejection and communicate with all relevant parties to determine the best course of action to resolve the issue.

Behavioral Questions

• 11. Can you describe a time when you had to handle a difficult or demanding client?
  In my previous role, I encountered a client who was consistently dissatisfied with our services and constantly requested changes to their medical claims. I was able to handle the situation by actively listening to their concerns, offering alternative solutions, and seeking input from my supervisor to ensure their needs were met while still adhering to company policies.
• 12. Have you ever had to work with a tight deadline and limited resources?
  Yes, I have had to complete a large volume of medical claims within a tight deadline while also experiencing technical issues with our claims processing software. I was able to manage the situation by prioritizing tasks, working efficiently, and staying calm under pressure. I also communicated with my team and IT department to troubleshoot and resolve the technical issues quickly.
• 13. Tell us about a time when you identified and resolved a mistake in a medical claim.
  In my previous role, I came across a claim that had been incorrectly coded, leading to a denial of payment. I was able to identify the mistake by carefully reviewing all relevant documentation and consulting with the healthcare provider. I then worked with my team to update the coding and resubmit the claim, resulting in successful payment.
• 14. Have you ever collaborated with other departments or teams to resolve a complex medical claim?
  Yes, I have collaborated with other departments in past roles to resolve complex medical claims. For example, I worked closely with our billing and coding team to ensure that all claims were accurately processed and that any issues were addressed promptly. I also consulted with our legal team on any legal or privacy concerns that may have arisen during the claims process.
• 15. Tell us about a time when you had to adapt to a new medical claims processing system or procedure.
  In my previous role, our company implemented a new claims processing system, and I was tasked with learning and using the new software. I adapted to the change quickly by attending training sessions, asking for assistance from my team and supervisor, and practicing on my own time. I was able to become proficient in the new system within a short period, and our team saw an increase in efficiency and accuracy in claims processing.

Situational Questions

• 16. How would you handle a situation where you discovered a fraudulent medical claim?
  If I were to encounter a potentially fraudulent claim, I would first carefully review all relevant documentation and data to confirm my suspicions. I would then report my findings to my supervisor and the appropriate authorities. I understand the seriousness of fraud in the healthcare industry and would handle any potential cases with urgency, discretion, and adherence to applicable laws and policies.
• 17. How would you handle a situation where a claim was denied due to a miscommunication with the healthcare provider?
  If a claim was denied due to miscommunication with the healthcare provider, I would first review all relevant communication and documentation to determine the source of the issue. I would then communicate with the insurer and the healthcare provider to clarify any miscommunications and gather any necessary information to resubmit the claim effectively.
• 18. What would you do if you noticed a discrepancy in a patient's medical records while processing a claim?
  If I noticed a discrepancy in a patient's medical records, I would first ensure that I had correctly identified the issue and that it was not a simple typo or error. I would then communicate with the healthcare provider to verify the information and resolve the discrepancy in the records before processing the claim.
• 19. How do you handle competing priorities when processing multiple medical claims?
  When faced with competing priorities, I prioritize tasks based on urgency, complexity, and deadline. I also communicate with my team and supervisor to ensure that all important tasks are addressed promptly. If needed, I can also delegate tasks or seek assistance to ensure that all claims are processed accurately and efficiently.
• 20. What would you do if you could not find a specific medical code for a procedure or diagnosis?
  If I could not find a specific medical code, I would first research the issue and consult any available resources or colleagues for guidance. If the code still cannot be found, I would document the issue and communicate with my supervisor to determine the best course of action, which may include seeking assistance from the healthcare provider or escalating the issue to the appropriate authorities.