25 Medical Claims Processor Interview

Questions and Answers

climbtheladder.com/medical-claims-processor-interview-questions/

January 5, 2023

Interview
Learn what skills and qualities interviewers are looking for from a medical
claims processor, what questions you can expect, and how you should go
about answering them.

Interview Insights
Published Jan 5, 2023
Medical billing and claims processing is a critical function in the healthcare
industry. It’s the job of the medical claims processor to ensure that
healthcare providers are reimbursed for the services they provide to
patients. This is a complex process that requires attention to detail and a
strong knowledge of medical terminology.

If you’re looking for a job in medical billing and claims processing, you’ll
likely need to go through a job interview. In order to make the best
impression on potential employers, you’ll need to be prepared to answer a
range of medical claims processor interview questions.

In this guide, we’ll provide you with a list of sample questions and answers
that you can use to help you prepare for your interview.

1. Are you comfortable working with a high volume of paperwork and

data entry?

This question can help the interviewer determine if you have the skills and
experience to succeed in this role. Use your answer to highlight your ability
to work with large amounts of data, organize information and complete tasks
within a deadline.

Example: “Absolutely! I have extensive experience working with high

volumes of paperwork and data entry. In my current role as a Medical
Claims Processor, I process up to 200 claims per day. I am very organized
and detail-oriented, which helps me stay on top of the workload. I also have
excellent problem solving skills that enable me to quickly identify errors in
the claims and take corrective action. Furthermore, I am proficient in using
various software programs related to medical claims processing such as
Microsoft Excel, Access, and QuickBooks. All these skills make me an ideal
candidate for this position.”

2. What are the different types of medical claims and which ones are
you most familiar with?

This question is a great way for the interviewer to assess your knowledge of
medical claims processing. It also allows them to see if you have experience
with their company’s specific type of claim. When answering this question, it
can be helpful to list out the different types of claims and briefly describe
each one.
Example: “I am familiar with all types of medical claims, including hospital
inpatient and outpatient claims, physician office visits, durable medical
equipment (DME) claims, laboratory services, radiology services, and home
health care. Of these, I have the most experience processing hospital
inpatient and outpatient claims.

I understand how to accurately enter patient information into the system,

verify insurance coverage, review documentation for accuracy, process
payments, and follow up on any discrepancies or denials. I also have a
good understanding of coding systems such as CPT, HCPCS, and ICD-10.
My attention to detail is one of my greatest strengths when it comes to
processing medical claims.”

3. How would you handle a claim that had missing or incorrect

information?

This question can help the interviewer assess your problem-solving skills
and ability to work with clients. Use examples from previous experience
where you helped a client or colleague resolve issues that affected their
claim.

Example: “When handling a claim with missing or incorrect information, I

would first review the documentation to determine what is missing and why.
If there are any discrepancies between the patient’s records and the
insurance company’s records, I would contact both parties to get
clarification on the issue. Once I have all of the necessary information, I can
then accurately process the claim.

I am also familiar with various coding systems such as CPT codes and ICD-
10 codes, so I can ensure that the correct codes are used when processing
the claim. This helps to minimize errors and ensures that the claim is
processed in a timely manner. Finally, I always double check my work
before submitting the claim for payment.”

4. What is your experience working with insurance companies?

This question can help the interviewer determine your level of experience
with insurance companies and how you might fit in at their company. If you
have no prior experience working with an insurance company, consider
describing a time when you had to work with a large organization or
corporation.

Example: “I have extensive experience working with insurance companies.

I have been a Medical Claims Processor for the past five years and during
that time, I have become well-versed in all aspects of medical claims
processing. I am familiar with the different types of insurance plans offered
by various carriers and understand their unique requirements when it comes
to filing claims.

In addition, I am experienced in dealing with customer service

representatives from multiple insurance companies. I have developed
strong communication skills which allow me to effectively explain complex
issues and negotiate payment terms on behalf of my clients. My ability to
stay organized and manage multiple tasks simultaneously has enabled me
to successfully process large volumes of claims in a timely manner.”

5. Provide an example of a time when you had to research and resolve

a claim issue.

Interviewers may ask this question to learn more about your problem-
solving skills and how you use them in the workplace. When answering, try
to describe a situation where you used research and critical thinking to solve
an issue or challenge that helped your company achieve its goals.

Example: “I recently had to research and resolve a claim issue for a patient.
The patient was being billed for an incorrect procedure code, which resulted
in the wrong amount of reimbursement from their insurance company. To
resolve this issue, I first researched the correct procedure code for the
service provided by reviewing the medical records and verifying with the
provider’s office. Once I identified the correct code, I contacted the
insurance company to explain the situation and requested that they adjust
the claim accordingly. After several back-and-forth conversations, the
insurer agreed to adjust the claim and reimburse the patient the correct
amount. This experience demonstrated my ability to research and resolve
complex claims issues quickly and effectively.”

6. If you had to explain the claims process to a patient who is not

familiar with it, what would you tell them?

This question is a great way to test your communication skills and ability to
explain complex processes in an easy-to-understand manner. When
answering this question, try to use simple language and avoid using industry
jargon or acronyms that the interviewer may not be familiar with.

Example: “The claims process is an important part of the healthcare

system. As a Medical Claims Processor, it’s my job to make sure that
patients receive the care they need in a timely manner.

When explaining the claims process to a patient who isn’t familiar with it, I
would start by telling them that their insurance company will review and pay
for certain medical services provided to them. This includes doctor visits,
hospital stays, medications, and other treatments. The insurance company
will then send a bill to the patient or their provider for any remaining balance
due after their coverage has been applied.

Next, I would explain how the claims processor fits into this process. My role
is to review the claim submitted by the provider, verify that all information is
accurate, and submit it to the insurance company for payment. Once the
claim is approved, I will ensure that the patient receives the appropriate
reimbursement from the insurance company.

Lastly, I would let the patient know that if there are any questions or issues
regarding their claim, they can contact me directly and I will be happy to
help.”

7. What would you do if you noticed a mistake in a patient’s contact

information while processing a claim?

This question can help the interviewer assess your attention to detail and
ability to solve problems. In your answer, describe how you would fix the
mistake and what steps you would take to ensure it doesn’t happen again.

Example: “If I noticed a mistake in a patient’s contact information while

processing a claim, my first step would be to double-check the accuracy of
the information. This could involve verifying the data against other sources
such as the patient’s medical records or insurance policy. If the mistake is
confirmed, I would then take steps to correct it. Depending on the type of
mistake, this could include contacting the patient directly to get updated
information, updating the system with the corrected information, and
sending out any necessary notifications to relevant parties. Finally, I would
document the process taken to ensure that all changes were properly
tracked. My goal would always be to make sure that claims are processed
accurately and efficiently so that patients receive their benefits without
delay.”

8. How well do you perform under pressure?

This question is a great way for employers to assess your ability to work
under pressure. When answering this question, it can be helpful to mention
how you manage stress and the ways in which you prioritize tasks when
working under time constraints.

Example: “I am very comfortable working under pressure. I have worked in

the medical claims processing field for over five years and understand how
important it is to stay focused and efficient when dealing with deadlines. In
my current role, I often have to process a large number of claims quickly
and accurately. I’m able to prioritize tasks and manage my time effectively
so that all claims are processed on time without sacrificing accuracy or
quality. I also have experience managing multiple projects at once, which
has helped me develop strong multitasking skills. My ability to remain calm
and organized when faced with tight deadlines ensures that all claims are
handled efficiently and correctly.”

9. Do you have experience using claim processing software?

This question can help the interviewer determine your level of experience
with medical claim processing software. If you have no prior experience, you
can describe what you would do if you were faced with using a new system
and how you would learn to use it.

Example: “Yes, I have extensive experience using claim processing

software. During my six years in the medical claims industry, I have used a
variety of different software programs to process and manage claims. I am
familiar with both web-based and desktop applications, as well as various
coding systems. I also have experience troubleshooting technical issues
related to claim processing software. In addition, I am comfortable working
with large datasets and can quickly identify discrepancies or errors in claims
data. My familiarity with these tools has enabled me to efficiently process
claims for multiple clients at once.”

10. When would you recommend that a patient make a payment for
their medical expenses?

This question can help the interviewer determine how you handle financial
transactions and whether you have experience with them. Use your answer
to highlight your customer service skills, ability to work independently and
attention to detail.

Example: “When it comes to recommending when a patient should make a

payment for their medical expenses, I believe that the best approach is to
consider the individual’s financial situation. If they are able to pay in full at
the time of service, this would be ideal as it reduces administrative costs
and allows for more efficient processing of claims. However, if the patient is
unable to pay in full, then I recommend discussing payment options with
them such as setting up an installment plan or utilizing third-party financing
options. It is important to ensure that the patient understands all of their
available options so that they can make an informed decision about how to
proceed. Ultimately, my goal is to help patients find a payment solution that
works for them while also ensuring that their medical bills are paid in a
timely manner.”
11. We want to improve our claims processing time. What strategies
would you suggest we implement?

This question is an opportunity to show your knowledge of the industry and

how you can help improve a company’s processes. When answering this
question, consider what challenges the company may be facing and offer
solutions that you have used in the past or seen other companies
implement.

Example: “I believe that the most effective way to improve claims

processing time is by streamlining the process. To do this, I would suggest
implementing a few strategies.

The first strategy I would recommend is automating certain parts of the

process. This could include using software to automatically enter data into
forms or create reports from existing information. Automation can help
reduce manual entry errors and speed up the overall process.

Another strategy I would suggest is improving communication between

departments. By having clear lines of communication, it will be easier for
teams to collaborate on tasks and ensure that all necessary steps are taken
in a timely manner.

Lastly, I would suggest investing in training for staff members who handle
claims processing. Training can help employees become more efficient and
knowledgeable about the process, which can lead to faster turnaround
times.”

12. Describe your experience working with physicians and other

medical professionals.

Employers ask this question to learn more about your interpersonal skills
and how you interact with others. When answering, it can be helpful to
mention a specific physician or medical professional that you’ve worked with
in the past and describe what made them stand out as an excellent
professional.

Example: “I have extensive experience working with physicians and other

medical professionals. In my current role as a Medical Claims Processor, I
am responsible for verifying insurance coverage, processing claims, and
providing customer service to both patients and providers. I have developed
strong relationships with many of the physicians in our network by ensuring
that their claims are processed quickly and accurately.
Additionally, I have worked closely with medical billing staff to ensure that all
paperwork is completed correctly and submitted on time. My ability to build
positive relationships with these professionals has enabled me to resolve
any issues that arise quickly and efficiently. Finally, I have also participated
in training sessions with medical professionals to help them understand the
claims process and how they can best utilize it to benefit their practice.”

13. What makes you a good fit for this position?

Employers ask this question to learn more about your qualifications and how
you can contribute to their team. Before your interview, review the job
description to see what skills they’re looking for in a candidate. In your
answer, share two or three of these skills that you possess and explain why
you have them.

Example: “I believe I am an excellent fit for this position because of my

extensive experience in medical claims processing. For the past five years, I
have worked as a Medical Claims Processor at ABC Company, where I was
responsible for reviewing and processing insurance claims for patients.
During that time, I developed strong knowledge of coding systems, billing
procedures, and other related processes.

In addition to my professional experience, I also have a Bachelor’s degree

in Health Administration from XYZ University. This has provided me with a
comprehensive understanding of healthcare operations, policies, and
regulations. My education has enabled me to stay up-to-date on industry
trends and best practices, which is essential for any successful Medical
Claims Processor.”

14. Which claim processing tasks do you enjoy the most?

This question can help the interviewer learn more about your personality
and how you approach work. It can also show them which skills you have
developed over time. When answering this question, it can be helpful to
mention a specific task that you enjoy doing and why.

Example: “I enjoy the challenge of reviewing and processing medical

claims. I find it rewarding to be able to accurately assess each claim and
ensure that all necessary information is included in order for a successful
outcome. My favorite part of this process is when I am able to identify
discrepancies or errors, which allows me to take corrective action quickly
and efficiently.
In addition, I also enjoy researching complex cases and finding solutions
that are beneficial to both the patient and the insurance company. This
requires an understanding of the different policies and regulations related to
medical claims, as well as staying up-to-date on any changes that may
occur.”

15. What do you think is the most important aspect of claim

processing?

This question is a great way for employers to learn more about your
priorities and how you would approach the role. When answering, it can be
helpful to think of an example from your experience that highlights this skill
or quality.

Example: “The most important aspect of claim processing is accuracy. It’s

essential that all claims are processed accurately and efficiently to ensure
that patients receive the care they need in a timely manner. As a Medical
Claims Processor, it’s my responsibility to review each claim for accuracy
and completeness before submitting them to insurance companies or other
payers. I also need to be able to identify any discrepancies between the
patient’s medical records and the submitted claims, as well as any coding
errors.

I have extensive experience with reviewing and processing medical claims,

so I understand how critical accuracy is in this role. I’m highly organized and
detail-oriented, which allows me to quickly spot mistakes and take corrective
action when necessary. I’m also familiar with various types of healthcare
software and can easily navigate through different systems to ensure
accurate data entry. Finally, I’m comfortable working with tight deadlines and
am confident that I can help your organization meet its goals for efficient
and accurate claim processing.”

16. How often do you make mistakes when processing claims?

This question can help the interviewer determine how much attention to
detail you have when working on claims. Your answer should show that you
are honest about your mistakes and learn from them.

Example: “I take great pride in my work and strive to ensure that I process
claims accurately and efficiently. I understand the importance of accuracy
when it comes to medical claims processing, so I make sure to double
check all of my work for errors before submitting a claim. In the rare
instance that I do make a mistake, I am quick to identify and correct it. I also
use any mistakes as an opportunity to learn and grow, ensuring that I don’t
make the same mistake twice.”
17. There is a claim that you don’t know how to process. What do you
do?

This question is a great way to test your problem-solving skills. It also shows
the interviewer that you are willing to ask for help when needed. Your
answer should show that you can identify the issue and find an alternative
solution or contact someone who can help you process it.

Example: “When I encounter a claim that I don’t know how to process, my

first step is to research the issue. I will consult with colleagues and review
relevant documents such as policy manuals or industry standards to gain an
understanding of the situation. If necessary, I can reach out to the insurance
company for clarification on any details. Once I have enough information, I
can then use my expertise to make an informed decision about how to best
process the claim.

I understand the importance of accuracy when it comes to medical claims

processing. I take great care in making sure all claims are processed
correctly and efficiently. I am confident that my experience and attention to
detail would be an asset to your team.”

18. What would you do if a patient or provider is not satisfied with the
outcome of their claim?

Interviewers may ask this question to assess your customer service skills
and how you would handle a challenging situation. In your answer, try to
highlight your problem-solving skills and ability to work with others to find
solutions that satisfy everyone involved.

Example: “If a patient or provider is not satisfied with the outcome of their
claim, I would first take the time to listen to their concerns and understand
why they are unhappy. Then, I would review all relevant documentation to
determine if there was an error in processing the claim. If so, I would work
quickly to correct it and ensure that the patient or provider receives the
proper reimbursement.

I also believe in being proactive when it comes to customer service. To

prevent similar issues from occurring in the future, I would use my
experience as a Medical Claims Processor to identify any potential
problems with the claims process and suggest improvements where
necessary. Finally, I would follow up with the patient or provider to make
sure that their issue has been resolved to their satisfaction.”

19. How do you stay organized when managing multiple claims at

once?
This question can help the interviewer assess your organizational skills and
how you manage multiple tasks at once. Use examples from past
experiences to highlight your ability to prioritize, plan ahead and meet
deadlines.

Example: “Staying organized when managing multiple claims is essential to

ensure that all claims are processed correctly and in a timely manner. To
stay organized, I use a combination of both digital and physical tools.

Digitally, I use a spreadsheet system to track the progress of each claim.

This allows me to quickly reference which claims have been completed,
what needs further attention, and any other relevant information. I also
utilize calendar reminders to keep track of deadlines for each claim.

Physically, I create folders for each claim so that all documents related to it
can be easily accessed. I also make sure to label each folder clearly with
the patient’s name and date of service. Finally, I prioritize my workload by
breaking down tasks into smaller chunks and tackling them one at a time.
This helps me stay focused on the task at hand and ensures that nothing
gets overlooked.”

20. Describe your experience dealing with customer service issues

related to medical claims.

Customer service is an important part of any job, and medical claims

processors often interact with patients who are frustrated about their
insurance coverage. Employers ask this question to make sure you have
experience working in customer service and can handle difficult situations.
In your answer, share a specific example of how you helped a patient
resolve a problem.

Example: “I have extensive experience dealing with customer service

issues related to medical claims. In my current role as a Medical Claims
Processor, I handle all types of customer inquiries and complaints regarding
their medical claims. I am adept at quickly assessing the issue, determining
the best course of action, and resolving it in an efficient manner.

I also take great pride in providing excellent customer service. I understand

that when customers are dealing with medical claims, they can be frustrated
or confused. My goal is always to provide them with clear answers and
solutions so that they feel heard and respected. I strive to make sure that
each customer leaves our conversation feeling satisfied and confident that
their claim has been properly handled.”

21. Are you familiar with HIPAA regulations and how they apply to
medical claims?

HIPAA, or the Health Insurance Portability and Accountability Act, is a

federal law that protects patient privacy. Employers ask this question to
make sure you understand how HIPAA applies to your work as a medical
claims processor. In your answer, explain what HIPAA is and why it’s
important to protect patients’ privacy. If you have experience working with
HIPAA-compliant software, mention that too.

Example: “Yes, I am very familiar with HIPAA regulations and how they
apply to medical claims. In my current role as a Medical Claims Processor, I
have worked extensively with these regulations. I understand the
importance of maintaining patient privacy and confidentiality in accordance
with HIPAA guidelines. I also ensure that all medical claims are processed
accurately and efficiently according to established protocols.

I stay up-to-date on any changes or updates to HIPAA regulations so that I

can remain compliant when processing medical claims. I take pride in
ensuring that all medical claims meet the highest standards for accuracy
and timeliness. Furthermore, I regularly review the claim forms to make sure
that all information is accurate and complete before submitting them.”

22. Do you have any experience in coding for medical claims?

This question is a great way for the interviewer to assess your coding skills
and how you apply them in your work. If you have experience with medical
coding, describe it in detail. If you don’t have any coding experience, explain
that you are willing to learn.

Example: “Yes, I have extensive experience in coding for medical claims.

During my previous role as a Medical Claims Processor, I was responsible
for accurately coding and processing all types of medical claims. This
included reviewing patient records to ensure accuracy and completeness,
entering codes into the system, and verifying that all information was
accurate before submitting the claim. I also worked with insurance
companies to resolve any discrepancies or issues related to the claims
process. My experience has given me an in-depth understanding of medical
coding and how it relates to the overall claims process. I am confident that I
can bring this knowledge and expertise to your organization and help you
achieve success.”

23. What strategies do you use to ensure accuracy when processing

claims?
Accuracy is a critical skill for medical claims processors. Employers ask this
question to make sure you have the skills necessary to complete your work
accurately and in a timely manner. In your answer, share two or three
strategies that help you process claims correctly. Explain why these
strategies are effective.

Example: “I understand the importance of accuracy when processing

medical claims. To ensure accuracy, I use a multi-step process that includes
verifying patient information and double-checking all calculations. First, I
review the claim to make sure all necessary information is present. This
includes confirming the patient’s name, insurance policy number, diagnosis
codes, and any other relevant details. Then, I check for any discrepancies
between the submitted documents and the patient’s records. Finally, I
carefully go through each line item on the claim form to make sure all
charges are accurate and up-to-date.

In addition, I also take advantage of technology to help me with my work.

For example, I use automated software to quickly compare rates and
calculate payments. This helps me save time while ensuring accuracy in my
calculations. With these strategies, I’m confident that I can provide reliable
and accurate results when processing medical claims.”

24. How do you handle difficult conversations with patients regarding

their payment responsibilities?

Interviewers may ask this question to assess your interpersonal skills and
ability to handle challenging situations. In your answer, try to highlight your
problem-solving and communication skills while also showing respect for the
patient’s situation.

Example: “When it comes to difficult conversations with patients regarding

their payment responsibilities, I believe in approaching the conversation with
empathy and understanding. I understand that these conversations can be
uncomfortable for both parties involved, so my goal is always to make sure
the patient feels heard and respected.

I start by explaining the payment policies clearly and concisely, making sure
to answer any questions they may have. Then, I listen carefully to their
concerns and try to come up with a solution that works best for them. This
could mean offering an alternate payment plan or helping them apply for
financial assistance. No matter what, I strive to ensure that the patient
understands their options and feels comfortable moving forward.”

25. What steps do you take to make sure all paperwork is correctly
filled out before submitting it to an insurance company?
This question can help the interviewer understand how you approach your
work and ensure that it’s done correctly. Use examples from past
experiences to show how you complete paperwork accurately and
efficiently.

Example: “When it comes to submitting paperwork to an insurance

company, accuracy is key. To ensure all paperwork is correctly filled out
before submission, I take the following steps:

1. First, I review each document carefully and make sure that all required
fields are completed accurately. This includes double-checking for any typos
or errors in spelling, grammar, and punctuation.

2. Then, I compare the information on the documents with the patient’s

records to confirm accuracy.

3. Finally, I use a checklist to verify that all necessary forms have been
included and that they are properly signed and dated.

These steps help me guarantee that all paperwork is complete and accurate
before it is sent off to the insurance company. With my attention to detail
and commitment to accuracy, I am confident that I can provide excellent
service as a Medical Claims Processor.”

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