Claims Adjuster Mock Interview

Practice 35 Claims Adjuster interview questions covering liability assessment, fraud detection, and settlement negotiations.

Question 28 of 35

How do you approach a claim that seems suspicious or potentially fraudulent?

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Krista Wenz
Krista Wenz

Krista Wenz has been on thousands of interview panels hiring EMS professionals and firefighters for public and private agencies.

According to a March 2023 study, between 10% and 20% of insurance claims are fraudulent. The interviewer asks this question to determine your process when you have a suspicious claim. When encountering a suspicious or potentially fraudulent claim, it is essential to approach it with caution and conduct a thorough investigation. Start by gathering all relevant information about the claim and the claimant, including any documentation or evidence provided. Look for any inconsistencies or red flags that may indicate fraud. Conduct interviews with the claimant and any witnesses to gather additional information and consult with experts in a particular field if necessary. Throughout the investigation, maintain open communication with the claimant andinform themd of any updates or findings. If evidence of fraud is discovered, report it to the appropriate authorities and take steps to prevent further fraudulent activity. The key is to remain objective, gather as much information as possible, and ensure a fair and accurate resolution. Describe your approach to these situations.

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