Claims interview prep.

A claims handler / adjuster owns the loss event from FNOL to closure: acknowledge promptly, investigate the facts, decide coverage, reserve the file accurately, negotiate the settlement, control LAE, and close, under statutory fair-claims-handling deadlines (NAIC Model 900) and the bad-faith...

What interviewers look for

  • Can the candidate walk a claim end-to-end. FNOL, investigation, coverage, reserve, negotiation, settlement, closure, with the steps in the right order?
  • Do they analyse COVERAGE before paying, declarations + insuring agreement + exclusions + endorsements, and know when to issue a reservation of rights or a denial?
  • Do they reserve disciplinedly, set a case reserve early, stair-step it as facts emerge, document the basis, and control LAE, rather than under-reserve to look good?
  • Do they spot fraud red flags (early-policy claim, no police report, prior claims pattern, inconsistent statements) and refer to SIU rather than pay quickly?
  • Do they handle distressed / angry / litigious customers professionally, empathy + clarity + statutory timelines, and understand the bad-faith risk if they don't?
  • Are they credentialed credibly (AIC / SCLA / CPCU) and aware of the regulatory + litigation environment (NAIC Model 900, the bad-faith bar)?

Behavioural questions to expect

  1. Walk me through your CV, and where are you on claims designations?

    What it tests: Story coherence + genuine fit for claims work + credible designation progression. Claims teams want analytical judgment, empathy, attention to documentation, and the AIC / SCLA / CPCU ladder progressing.

  2. Tell me about a difficult claim or judgment call you've owned.

    What it tests: Judgment under pressure + the willingness to land a coverage / reserve / settlement call and defend it. Tests whether the candidate works through facts, applies the policy, and communicates the result.

  3. Tell me about a weakness, a failure, or feedback you've received and worked on.

    What it tests: Self-awareness + process discipline. Cross-role canonical. Fake weaknesses downgrade immediately. Claims mistakes (under-reserving, missed coverage exclusion, blown deadline) compound into bad-faith exposure, so honesty about a process error and the fix matters.

  4. Why claims, and why insurance?

    What it tests: Authentic fit for the role: judgment under uncertainty + customer empathy + documentation discipline. Tests whether the candidate is drawn to the loss-event work (vs underwriting's risk selection or actuarial's modelling) and grasps that claims is the carrier's promise made real.

  5. Which claims seat would you want, desk, field, complex / litigation, or SIU, and why?

    What it tests: Genuine fit + grasp of how the seats differ. Tests whether the candidate has a reasoned preference (desk = volume + phone + lower severity; field = on-site investigation; complex / litigation = high-severity, attorney-represented; SIU = fraud) rather than a random one.

  6. Why this firm?

    What it tests: Whether the candidate has done the homework. Bar: firm-specific evidence from the lines, the claims operation, the systems, and the credentialing support, not generic 'strong carrier'.

  7. How would you describe this firm's book and claims operation in your own words?

    What it tests: Whether the candidate has internalized HOW the carrier handles claims, its lines, its operating model, its systems, and any live claims debate, not just that it 'pays claims'. Tests whether they've read its results / posture.

  8. How does the claims function actually drive value at a carrier?

    What it tests: Whether the candidate understands claims isn't a back-office function: loss + LAE control drives the loss ratio + combined ratio, reserve accuracy drives reported earnings, and the customer experience drives retention.

Technical concepts to master

Claims lifecycle + FNOL discipline

FNOL + statutory acknowledgement
First Notice of Loss starts the file; NAIC Model 900 + state law require prompt acknowledgement (commonly 10-15 business days) and prompt action.
Investigation
Gather the facts needed to apply the policy: statements, scene, photos, reports, medicals, vendor estimates, expert reconstruction.
Negotiation + settlement
Evaluate damages, negotiate within authority, settle; for liability: demand vs offer; for property: ACV vs RCV; for BI: medicals + lost wages + future care.
Subrogation + salvage + closure
Pursue third-party recovery (subro), recover salvage on damaged property, document the closing, and close cleanly.

Coverage analysis + reservation of rights

The four-lens coverage read
Declarations (who / what / limits) -> insuring agreement (what triggers coverage) -> exclusions (what knocks it out) -> conditions + endorsements (insured duties + modifications).
Reservation of rights (ROR)
Written notice that the carrier is investigating or handling without waiving coverage defenses; cites specific policy provisions in play.
Written denial
Formal denial letter citing the specific policy language + facts that defeat coverage; provides the appeal / complaint path required by state law.
Coverage counsel
Outside counsel specialized in coverage analysis, retained on complex / large / litigated coverage questions to opine on the position.

Reserving + LAE control

Initial case reserve
The handler's estimate at file open (or shortly after) of the most-likely ultimate indemnity + ALAE based on known facts and line benchmarks.
Stair-step discipline
Re-evaluate reserves at key milestones (investigation complete, suit filed, demand received, mediation, trial setting) and move them as facts justify.
ALAE vs ULAE
ALAE (Allocated Loss Adjustment Expense) is file-specific defense + expert + IME costs; ULAE (Unallocated) is general claims-operating overhead.
Reserve adequacy + actuarial roll-forward
Aggregate case reserves + IBNR (actuarial) = total reserves; the actuarial team measures handler reserve adequacy via emergence vs expected.

Fraud, litigation, + bad faith

Fraud red flags + SIU referral
Indicators (early-policy claim, no report, prior pattern, inconsistencies, staged-accident markers) trigger SIU referral for deeper investigation.
Litigation management + panel counsel
When suit is filed, retain defense counsel (usually from a panel), set litigation reserve + plan, manage strategy + ALAE.
Bad faith / extra-contractual
Carrier liability beyond the policy limit when handling is unreasonable: delay, denial without basis, failure to settle within limits, misrepresentation.
NAIC Unfair Claims Settlement Practices (Model 900)
The model US law on fair claims handling: acknowledge promptly, investigate reasonably, communicate decisions, pay or deny within statutory windows, no misrepresentation.

Practical drills

  • A bodily-injury liability claim opens with the following facts: ER + 3-day inpatient stay (medicals to date $35k); expected future care + PT $20k; lost wages 8 weeks at $1,500 (estimate $12k); pain + suffering exposure assess at 1.5x specials; defense counsel retained, $8k expected through mediation; one expert ($3k). Policy limit $250k. (a) Build the most-likely indemnity reserve. (b) Add ALAE. (c) State the total file reserve + your stair-step plan.
  • You're a claims handler at this firm on a line in its book. Walk me through how you'd handle the claim from FNOL to closure. Be ready to be probed on the statutory clock, the coverage read, the reserve, and the recoveries.
  • A homeowners claim comes in: water damage to the kitchen floor + cabinets, reported on day 47. The policy excludes 'continuous or repeated seepage of water over 14 or more days' but covers sudden + accidental discharge. The insured says it 'just appeared' on day 45 from under the sink. Photos show some staining + cupping that look gradual. Walk me through the coverage decision.

Smart-question anchors

  • Lines + seats - the lines the team handles, the desk / field / complex / SIU split, and what the role would specifically own
  • Operating model + systems - claims platform (Guidewire ClaimCenter / Duck Creek / proprietary), digital FNOL, photo / virtual estimating, telematics
  • Reserve + LAE discipline - case-reserve standards, supervisor review cadence, LAE / vendor management approach
  • Fraud + SIU - SIU structure, AI / analytics fraud tools, anti-fraud partnerships
  • Litigation + bad-faith posture - panel counsel use, jurisdictional exposure, recent material verdicts if disclosed

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