Describe a time when you identified a mistake or discrepancy in a claim. How did you rectify it?

In my previous role as a Claims Examiner, I came across a claim where the policyholder had submitted medical reports with conflicting information. To rectify the mistake, I immediately reached out to the policyholder to clarify the discrepancy. We scheduled a meeting where I carefully reviewed the medical reports with them, asking detailed questions to better understand the situation. During this process, I discovered that there had been a miscommunication between the policyholder and their healthcare provider, resulting in the conflicting information. I promptly contacted the healthcare provider to verify the accurate details and obtain the necessary documentation. Once I had all the correct information, I updated the claim file and proceeded with the assessment. This experience taught me the importance of thorough communication and attention to detail when verifying claim information.

During my time as a Claims Examiner, I encountered a case where a policyholder submitted a claim with incorrect prescription information. To rectify the mistake, I first analyzed the claim thoroughly, paying close attention to the prescription details and cross-referencing them with the policy coverage. Upon identifying the discrepancy, I reached out to the policyholder to discuss the issue and obtain clarification. Through effective communication, I discovered that the policyholder had mistakenly provided outdated prescription information. To rectify the situation, I requested the updated prescription information from the policyholder and initiated contact with their healthcare provider to verify its accuracy. Once the correct information was obtained, I updated the claim file and processed it accordingly. This experience highlighted the importance of data analysis, effective communication, attention to detail, and critical thinking in rectifying mistakes in claims.

As a dedicated Claims Examiner, I encountered a complex claim involving property damage. Upon thorough analysis of the claim documents, I identified a discrepancy in the reported date of the incident, which had a significant impact on the policy coverage. To rectify this mistake, I initiated an in-depth investigation, which involved gathering additional evidence, such as witness statements and photos of the damaged property. I also requested access to surveillance footage from nearby establishments to corroborate the claimant's account. Through effective communication with all relevant parties, including the claimant, witnesses, and property management, I was able to establish the correct date of the incident. This required meticulous attention to detail and critical thinking in piecing together the timeline of events. Once the accurate information was obtained, I updated the claim file, ensuring compliance with legal requirements and company policies. This experience not only showcased my expertise in data analysis, effective communication, attention to detail, critical thinking, and time management but also demonstrated my commitment to ensure fair outcomes for policyholders.