6 Auto Claims Adjuster Interview Questions and Answers

Introduction

Accurate, consistent vehicle inspections and cost estimates are core responsibilities for a junior auto claims adjuster. This evaluates technical knowledge of vehicle damage assessment, familiarity with local repair standards and ratecards (e.g., Indian garages and insurer rate guides), and ability to document findings for claims processing.

How to answer

• Start by describing your arrival and safety checks at the scene or garage (ensure occupant safety, vehicle stability, traffic control if roadside).
• Explain how you conduct a systematic inspection: exterior, interior, chassis/undercarriage, mechanical systems, and safety systems (airbags, seatbelts).
• Mention using a checklist and photographing all damage from multiple angles, including VIN, odometer, and registration details.
• Describe how you differentiate between accident-related damage and pre-existing or wear-and-tear issues (ask claimant history, compare photos if available).
• Explain how you convert damage observations into a repair estimate using insurer ratecards, local labour rates, O.E.M. vs aftermarket parts considerations, and part sourcing timelines (mention familiarity with local market: authorised workshops vs independent garages).
• Discuss escalation steps: when to involve a senior adjuster, salvage/replacement recommendations, or request workshop repairer quotes.
• Close with how you document findings in the claim file and communicate the estimate and next steps clearly to the claimant and workshop.

What not to say

• Guessing repair costs without describing a method or using rate references.
• Focusing only on photos without physical checks or asking for vehicle history.
• Failing to mention safety checks or legal/registration verification.
• Saying you would always rely solely on workshop invoices without independent assessment.

Example answer

“On attending a small car claim, I first ensure safety and record the claimant's details and vehicle documents (RC, insurance). I use a standard checklist: inspect exterior panels, lights, bumper, windscreen, check underbody for suspension damage, and confirm airbag deployment. I photograph all damage, VIN, odometer, and any pre-existing scratches. I then cross‑reference damage with the insurer's rate card and local labour rates (for India, I differentiate authorised dealer part costs vs aftermarket parts common in neighbourhood workshops). If structural or mechanical damage is suspected, I order a workshop estimate and recommend an inspection by a senior adjuster for potential total loss. I log everything in the claim file and explain the estimate and expected repair timeline to the claimant in simple terms.”

Introduction

Claims adjusters regularly manage emotional or stressed customers. This behavioral question evaluates communication skills, empathy, ability to de-escalate, follow company policy, and protect the insurer from fraud or premature settlements.

How to answer

• Use the STAR structure (Situation, Task, Action, Result) to organize your response.
• Briefly set the context: why the claimant was upset and any constraints (financial urgency, vehicle needed for livelihood, cultural considerations in India like reliance on two-wheeler for work).
• Describe your actions to listen actively, acknowledge their concerns, and explain the insurer's process and rationale in clear, non-technical language.
• Discuss practical steps you offered: interim support options (cashless repair network, temporary transport solutions, referral to customer assistance), timelines, and any required documentation.
• Explain how you balanced empathy with adherence to anti-fraud and regulatory procedures—what you escalated or documented.
• End with the outcome and what you learned about customer handling and process improvements.

What not to say

• Saying you ignored the claimant's emotion or dismissed their request.
• Claiming you personally provided cash settlements outside company rules.
• Being vague about outcome or failing to show any measurable resolution.
• Overemphasizing policy enforcement without empathy or alternatives.

Example answer

“In a previous role at a Mumbai claims desk, a female two-wheeler rider was distressed because she relied on her bike for daily deliveries and requested immediate cash. I first listened without interruption and validated her situation. I explained the standard settlement process and why immediate cash outside procedure wasn't possible. Then I offered alternatives: arranging a cashless repair at a nearby network garage to reduce downtime, connecting her with a temporary commuter allowance that our insurer approved in urgent cases, and fast-tracking document collection with clear steps. I documented the interaction and escalated for expedited approval. The claimant accepted the cashless repair option and was satisfied with regular updates, and the claim processed within the revised timeframe. I learned the value of offering practical, policy-compliant alternatives promptly.”

Introduction

Fraud detection and sound investigative judgment protect insurers' financials and ensure honest claimants are served fairly. This situational/competency question assesses analytical thinking, knowledge of fraud indicators, use of investigative tools, and escalation processes appropriate in India.

How to answer

• Identify and list the specific red flags you noticed (inconsistent statements, edited images, unfamiliar garage with inflated estimate).
• Explain immediate verification steps: contact claimant for clarification, request original unedited photos (timestamped), obtain vehicle documents and FIR if required, and ask for repair history.
• Describe verification with third parties: contact the garage, request itemised bills, cross-check garage registration and past dealings, and consult the insurer's panel/list of authorised workshops.
• Mention technical checks: using image metadata, geolocation, or forensic tools (if available), and comparing damage patterns with the accident description.
• State when and how you'd escalate: to a senior investigator, special investigations unit (SIU), or legal team; or recommend an independent surveyor or spot inspection.
• Discuss communication and compliance: locking provisional payouts, informing the claimant of delays with clear reasons, and maintaining documentation for regulatory/audit purposes.
• Conclude with decision criteria: accept if inconsistencies resolved and evidence corroborates; deny or recover if deliberate fraud proven, following due process and local regulations (IRDAI guidelines in India).

What not to say

• Accusing the claimant immediately without investigation or documentation.
• Relying solely on gut feeling instead of evidence and escalation protocols.
• Failing to mention compliance with legal and regulatory steps when denying a claim.
• Ignoring internal escalation channels or not documenting the investigation.

Example answer

“Seeing multiple red flags, I would first contact the claimant calmly to point out inconsistencies and request original timestamped photos and any accident documentation (FIR, towing receipt). Simultaneously, I'd contact the named garage to verify their registration and request a detailed itemised estimate with part numbers. I would run basic photo metadata checks; if still doubtful, I'd instruct a local surveyor to perform a spot inspection. If discrepancies persist—such as edited images or an inflated bill from an unverified workshop—I would escalate to the insurer's SIU for deeper forensic checks while putting the claim on hold per procedure. If SIU confirms fraud, we proceed with claim denial and recovery processes complying with IRDAI and company protocols; if evidence supports the claimant, we process payment. Throughout, I would keep the claimant informed of steps and expected timelines.”

Introduction

Auto claims adjusters must assess total-loss claims accurately while detecting fraud and complying with provincial regulations (e.g., Ontario, Quebec, British Columbia). This question tests technical knowledge of investigations, evidence collection, and regulatory awareness important in Canadian claims handling.

How to answer

• Start with a structured approach: immediate safety/containment, triage, and establishing a timeline of events.
• Explain steps to gather evidence: photos of the vehicle and scene, police reports, witness statements, diagnostic/repair estimates, vehicle history (VIN checks), and tow/storage documentation.
• Describe how you would evaluate total-loss: salvage value, ACV (actual cash value) calculation, and provincial rules affecting write-off or registration status.
• Outline red flags for fraud (inconsistent statements, recently purchased policy, staged-damage patterns) and how you'd escalate: request forensic inspection, contact SIU/fraud unit, and preserve chain of custody for evidence.
• Show awareness of provincial differences (for example, how Quebec SAAQ or British Columbia ICBC processes may affect claim handling) and compliance with privacy laws when obtaining records.
• Finish by describing communication steps with the claimant, repairers, and legal/fraud teams and how you document decisions to ensure auditability.

What not to say

• Claiming you would make a quick total-loss payment without sufficient evidence or documentation.
• Saying you would bypass fraud protocols or skip contacting the fraud unit if suspicious.
• Focusing only on the vehicle’s mechanical aspects and ignoring legal/regulatory or documentation requirements.
• Asserting judgments about claimants without objective evidence or failing to document investigative steps.

Example answer

“First, I'd secure all immediate documentation — photos, police report, tow invoice and witness statements — and order a vehicle history and salvage valuation. I’d calculate ACV using market research for comparable vehicles and subtract salvage and unpaid loan balances as per provincial guidance. Noting inconsistent claimant statements and recent policy inception, I would flag the file to our fraud unit and arrange a forensic inspection while preserving chain of custody for photos and reports. Throughout, I'd keep clear notes, update the claimant on next steps, and ensure any payment decisions comply with Ontario regulatory requirements and our company fraud procedures.”

Introduction

This behavioral question assesses communication, empathy, negotiation, and customer-service skills — critical for adjusters who must de-escalate conflict while protecting the insurer’s interests.

How to answer

• Use the STAR (Situation, Task, Action, Result) format to structure your answer.
• Describe the specific context (policyholder, type of damage, why they were upset) and your responsibility in the case.
• Explain the actions you took to de-escalate: active listening, validating feelings, clarifying misunderstandings, and re-explaining the rationale behind the offer with evidence.
• Show negotiation techniques: exploring alternatives, offering options (e.g., second estimate, mediation, re-inspection), and involving supervisors when appropriate.
• Quantify the result if possible (claim resolved, claimant accepted revised offer, reduced complaint escalation) and highlight what you learned about managing similar situations.

What not to say

• Saying you ignored their concerns or told them to take it up with complaints without engagement.
• Claiming you always stick rigidly to initial offers without room for discussion.
• Taking claims personally or admitting to arguing with claimants.
• Failing to show any measurable outcome or lesson learned from the interaction.

Example answer

“A claimant in Alberta was furious after their comprehensive claim offer didn’t cover a rental car they expected. I listened without interruption to understand their priorities, validated their frustration, and reviewed the policy with them, pointing to specific coverage limits and the basis for our estimate. I arranged a re-inspection with a senior appraiser and offered to assist with locating an affordable short-term rental while we re-evaluated. After the re-inspection we found a missed accessory that increased the settlement slightly; the claimant accepted the revised amount and filed no complaint. The experience reinforced the value of listening, clear policy explanation, and involving senior reviewers when needed.”

Introduction

In catastrophe or surge scenarios, adjusters must triage claims, allocate resources, and coordinate with vendors efficiently. This situational question evaluates planning, prioritization, and operational coordination skills under pressure.

How to answer

• Start by explaining rapid triage criteria: immediate safety issues (injuries, unroadworthy vehicles), time-sensitive exposures (towed vehicles, storage deadlines), and high-severity claims (total losses).
• Describe how you would communicate upfront with claimants about expected timelines and interim supports (towing, emergency repairs, rental coverage).
• Explain resource management: reassigning tasks, using vendor networks (tow, glass, mobile repair), requesting catastrophe team escalation, and leveraging triage teams where available.
• Discuss documentation and workflow control: concise initial notes, setting reminders for required follow-ups, and using claim-mgmt system priorities to track status.
• Address stakeholder coordination: inform supervisors of capacity limits, coordinate with supplier partners for surge capacity, and escalate any potential regulatory or media-sensitive issues.
• Conclude with how you’d monitor outcomes and report metrics (clearance rates, customer satisfaction, vendor turnaround) to improve ongoing response.

What not to say

• Working claims strictly in chronological order without triage during a surge.
• Ignoring claimants’ communication or failing to set expectations about delays.
• Attempting to handle every task yourself instead of delegating or escalating.
• Neglecting documentation because of workload volume.

Example answer

“I’d perform a rapid triage: prioritize any claims with injuries or imminent exposures, then those at risk of storage/tow fees, followed by high-value or total-loss files. I’d communicate an initial timeline to all claimants and arrange emergency vendor support (mobile repairs or towing) for those stranded. I’d request temporary surge support from our catastrophe team and reassign lower-priority admin tasks to support staff. Using our claims system, I’d flag priority files and set clear follow-up reminders. I’d update my manager on capacity and escalate any complicated liability or fraud concerns. This approach ensures safety and cost control while keeping customers informed during a high-volume event.”

Introduction

Auto claims adjusters in Italy must detect and investigate fraudulent claims to protect insurers' profitability and comply with legal requirements (e.g., Codice delle Assicurazioni). This question assesses your analytical judgement, knowledge of red flags, and ability to coordinate investigations with internal and external parties.

How to answer

• Start with a brief context: who the claimant was, the claim type (collision, staged accident, whiplash, etc.), and why it raised suspicion.
• List the concrete red flags you observed (inconsistent statements, mismatched damage, suspicious timing, gaps in documentation, medical provider patterns, vehicle repair history).
• Explain the steps you took: interviews, site inspections, photo/video forensics, telematics/GPS data review, checking prior claims in the policy system, and liaising with special investigations unit (SIU) or law enforcement when appropriate.
• Describe how you collaborated with third parties (repair shops, medical experts, carabinieri/police, surveillance vendors) and internal teams (legal, SIU, underwriting).
• Share the outcome with metrics where possible (claim denied, reduced payout, recovery of funds, legal action) and what controls or process changes you recommended afterward.
• Conclude with lessons learned and how you applied them to improve future fraud detection (updated checklists, training, or process changes).

What not to say

• Claiming you immediately denied the claim without proper investigation or documentation.
• Focusing only on accusing the claimant without describing objective evidence or procedure.
• Omitting collaboration with legal or law enforcement when escalation was needed.
• Using vague descriptions like "I suspected fraud" without concrete steps or outcomes.

Example answer

“In my previous role at a regional office handling policies from providers like Generali and UnipolSai, a claimant reported a rear-end collision but photos showed minimal bumper damage inconsistent with reported injuries. I documented the inconsistencies, interviewed witnesses, and reviewed the CCTV from nearby businesses. I also checked the claimant's medical provider history and prior claims in our system, which showed a pattern of minor claims. After consulting the SIU and presenting collated evidence, we denied the inflated soft-tissue injury portion and negotiated a reduced settlement for verified vehicle damage. The case led us to introduce a mandatory checklist for low-impact collisions and extra verification steps for repeat claimants.”

Introduction

Senior adjusters must manage emotionally charged interactions while protecting the insurer's interests and ensuring compliance with Italian consumer protection and claims procedures. This situational question evaluates interpersonal skills, de-escalation technique, and process discipline.

How to answer

• Open by acknowledging the policyholder's emotions—show empathy and active listening to reduce tension.
• Briefly and calmly explain the claims process, timelines, and what can/cannot be resolved immediately (e.g., cash settlement vs. formal assessment).
• Outline immediate practical steps you would take on scene: secure safety, collect evidence, record statements, and provide clear next steps and expected timelines.
• If the claimant demands payment, explain company policy and legal constraints in a non-confrontational way, offering interim solutions where appropriate (e.g., temporary mobility support, towing, replacement vehicle options if covered).
• State when and how you would escalate: involve your manager, legal, or customer relations if threatened with litigation, and document the interaction meticulously (dates, times, witnesses).
• Mention follow-up communication: confirm details in writing (email/Pec if required), provide contact points, and set clear deadlines for the next update.
• Include any cultural or local considerations relevant in Italy (e.g., preference for in-person explanations, importance of clear paperwork in Italian).

What not to say

• Getting defensive, arguing, or matching the claimant's anger.
• Promise immediate payments or outcomes you cannot authorize.
• Failing to document the encounter or neglecting to escalate appropriately.
• Using jargon or unclear language instead of plain Italian explanations.

Example answer

“At a roadside accident near Milan, a driver became very upset and demanded immediate cash, threatening legal action. I first listened and acknowledged his distress, saying I understood how stressful this is. I explained the insurer's obligations and that I needed to complete an assessment to determine liability and valid coverages. To reduce immediate hardship, I arranged a tow and temporary mobility assistance per his policy and provided a clear timeline for the assessment (within 48 hours) and a named contact. I documented the conversation on my tablet, photographed the scene, and informed my supervisor and legal team about the threat of litigation. Follow-up was sent in writing the same day. The claimant calmed down and accepted the interim support; we closed the claim within policy terms after assessment.”

Introduction

Senior adjusters must accurately determine total loss versus repairable damage to manage settlement costs, salvage value, and compliance with Italian practices (including reimmatricolazione, rottamazione, and fiscal implications). This competency question checks technical valuation knowledge, legal awareness, and negotiation skills with repairers and salvage buyers.

How to answer

• Define the total loss threshold used by your insurer (percentage of vehicle value or repair cost vs. pre-accident market value) and reference relevant local practices.
• Describe how you determine pre-accident market value: using comparable listings (portali come AutoScout24), dealer quotes, official market guides, and vehicle history (mileage, previous damage).
• Explain how you estimate repair costs: detailed shop estimates, OEM vs aftermarket parts, and taking into account structural/frame repairs that may affect safety and residual value.
• Discuss how salvage value is assessed: inspection of salvageable components, quotes from wrecking yards, and consideration of re-sale channels (demolition, spare parts market, EU cross-border sales).
• Outline the decision process: compare repair estimate + salvage value to market value, consult underwriting/legal if near threshold, and document the rationale.
• Mention negotiation and customer communication: explaining options to the policyholder (repair vs. indemnity), offering assistance with transfer of ownership, and handling tax/registration consequences in Italy.
• Include post-decision steps: arrange salvage removal, sale, or tender; ensure proper paperwork (libretto, certificato di proprietà or PRA procedures), and update claims records.

What not to say

• Relying solely on a single repair estimate or subjective opinion without market data.
• Ignoring legal/tax implications of total loss determinations in Italy.
• Failing to document valuation methodology or obtain salvage quotes.
• Automatically choosing repair or total loss without considering cost-benefit and customer preferences.

Example answer

“I start by determining the vehicle's pre-accident market value using AutoScout24 comparables, dealer quotes, and mileage/trim adjustments. Next, I obtain a detailed repair estimate from an authorized bodyshop with OEM pricing and a structural assessment. I then get salvage offers from local demolition yards and national salvage networks. If repair cost minus salvage recovery exceeds our insurer's total loss threshold (for example, 60–70% of market value depending on the policy), I recommend a total loss settlement. I present the claimant with a clear breakdown: market value, deductible, and net indemnity, and offer to handle PRA transfer and scrap documentation. In one case with a Fiat 500, this method saved the company ~€3,200 versus pursuing expensive structural repairs and expedited the claimant receiving indemnity within 10 days.”

Introduction

This question is vital for assessing your analytical skills, attention to detail, and ability to navigate complexities in auto claims, which are common in this role.

How to answer

• Use the STAR method (Situation, Task, Action, Result) to structure your response
• Clearly define the complexity of the claim, including any unique circumstances
• Detail the steps you took in the investigation and assessment process
• Discuss how you collaborated with other parties (e.g., clients, repair shops, legal teams)
• Highlight the outcome and any lessons learned that improved your future claims handling

What not to say

• Giving vague or broad claims that lack specifics
• Overemphasizing technical jargon without explaining your thought process
• Failing to mention any collaboration with team members or stakeholders
• Neglecting to discuss the outcome or impact of your actions

Example answer

“At Aviva Canada, I managed a particularly complex claim involving a multi-vehicle accident with disputes over liability. I conducted interviews with all parties, collected police reports, and analyzed witness statements. By collaborating with our legal team, I ensured we communicated effectively with the clients throughout the process. Ultimately, we resolved the claim in favor of our client, leading to a payout that was 20% lower than initially estimated, demonstrating my ability to negotiate effectively and maintain client satisfaction.”

Introduction

This question tests your understanding of regulatory frameworks and your commitment to compliance, which is crucial in the insurance industry.

How to answer

• Discuss specific regulations relevant to auto insurance in Canada, such as the Insurance Act
• Explain your process for staying updated on changes in policies and regulations
• Describe how you incorporate compliance checks into your claims handling process
• Provide examples of how you have successfully navigated compliance challenges
• Highlight the importance of training and educating team members on compliance

What not to say

• Implying that compliance is not very important or is secondary to customer service
• Failing to acknowledge specific regulations or company policies
• Describing a lack of process in ensuring compliance
• Overlooking the need for ongoing education and training

Example answer

“I prioritize compliance by closely following the Insurance Act and regularly attending industry seminars. For each claim, I implement a checklist that ensures all regulatory requirements are met before finalizing. At Intact Insurance, I addressed a situation where a new procedure was introduced without proper training. I initiated a training session for my team, which not only ensured compliance but also improved our claims processing time by 15%.”

Introduction

Claims supervisors in the UK must balance throughput with accuracy and regulatory compliance (e.g., FCA expectations and Data Protection). This question evaluates your operational leadership, prioritisation, and ability to sustain service levels under pressure.

How to answer

• Use the STAR structure: Situation, Task, Action, Result.
• Clearly set the context (type of claims, volume spike, business impact) and reference any regulatory or SLA constraints.
• Explain how you assessed priorities and redistributed workload (e.g., triage criteria, overtime, temporary redeployment).
• Describe steps you took to protect quality and compliance (checklists, sampling audits, buddy checks, escalation points).
• Quantify outcomes (reduced backlog %, SLA attainment, error rate) and note lessons learned for process improvement.

What not to say

• Focusing only on hitting numbers without mentioning quality or compliance safeguards.
• Claiming you handled everything personally without delegating or acknowledging team input.
• Vague descriptions like 'we worked harder' instead of concrete actions and results.
• Not mentioning regulatory/data-protection considerations pertinent to UK claims handling.

Example answer

“At Aviva, during a post-storm surge in household claims, our team faced a 60% increase in intake with a 7-day SLA. I immediately introduced a triage step to separate emergency/high-priority claims from routine cases, redeployed two experienced handlers from lower-risk lines, and set up hourly huddles to unblock issues quickly. To protect accuracy, I ran a 10% random sampling QA and instituted a 'two-eye' sign-off for complex settlements. Within two weeks we cleared the backlog, maintained 95% SLA compliance, and reduced rework by 18%. I documented the temporary workflow so we could re-deploy it for future spikes.”

Introduction

Supervisors must balance customer service with fraud prevention and regulatory obligations. This scenario tests judgement, investigative approach, stakeholder management and knowledge of fraud indicators and escalation pathways.

How to answer

• Begin by outlining immediate steps to preserve evidence and avoid premature payment (put a hold, record decision rationale).
• List key fraud indicators you would check (inconsistent statements, suspicious documentation, prior history, third-party intelligence).
• Explain how you'd coordinate with internal teams (fraud investigations, legal, compliance) and use external checks (CIFAS, Claims and Underwriting Exchange where relevant).
• Describe how you'd communicate with the account manager and claimant—clear, factual, and balancing tone to protect relationship while following process.
• State when and how you'd escalate (to SIU or senior management) and document decisions to maintain audit trail.

What not to say

• Agreeing to immediate payment to 'keep the customer happy' without due diligence.
• Making accusations without a systematic investigation or evidence.
• Ignoring internal fraud protocols or failing to involve fraud specialists.
• Being evasive about regulatory obligations or failing to document the process.

Example answer

“If an account manager pushed for quick settlement, I'd place a temporary payment hold citing routine verification checks, then conduct a focused review for red flags (discrepancies in the timeline, duplicate invoices). I'd notify the specialist fraud team and run checks through CIFAS/CUE. I would brief the account manager transparently: explain the need for checks, the likely timeline, and how we can keep the claimant informed without suggesting suspicion. If the fraud team found concerning evidence, I'd escalate to SIU and involve legal; if cleared, we'd proceed promptly and apologise for any delay. Throughout, I'd log every step to ensure an auditable trail and protect both the customer relationship and the insurer from loss.”

Introduction

Supervisors must develop their teams to maintain quality, morale and efficiency. This behavioural question evaluates coaching ability, performance management, and empathy, important in UK workplaces with strong employment and equality standards.

How to answer

• Start by describing the performance issue with specific metrics (e.g., throughput, accuracy, customer complaints).
• Explain how you diagnosed root causes (observation, 1:1s, reviewing work samples, seeking feedback).
• Detail the coaching plan you put in place (SMART objectives, training, shadowing, regular feedback cadence).
• Describe measurable improvements and any wider team benefits (reduced errors, improved CSAT).
• Reflect on how you handled sensitive HR aspects and any ongoing development actions.

What not to say

• Solely blaming the employee without showing how you supported them.
• Describing punitive measures as the first option rather than coaching.
• Failing to provide measurable outcomes or follow-up.
• Ignoring diversity, fairness or reasonable adjustments where relevant.

Example answer

“I managed a handler whose settlement accuracy had fallen, causing a spike in rework. After private 1:1s and reviewing their caseload, I found they were unsure about new policy changes and struggling with time management. I set a 6-week plan with daily mentoring sessions, shadowing of a high-performing peer, and targeted policy refresh training. We tracked accuracy weekly; by week six their error rate halved and throughput improved 20%. I also worked with HR to ensure any workload pressures were addressed. The handler gained confidence and later became a peer mentor for new starters.”

Introduction

Claims managers in Canada must keep teams compliant with federal and provincial regulations (FSRA in Ontario, AMF in Quebec, provincial consumer protection rules). This question evaluates leadership, change management, regulatory knowledge and the ability to balance compliance with service levels.

How to answer

• Open with the context: specify the regulation or rule change, the timeline, and the business impact (e.g., longer processing times, new documentation requirements).
• Use the STAR structure: describe the specific actions you took to translate regulatory requirements into operational changes.
• Explain stakeholder engagement: how you worked with legal/compliance, operations, IT and external partners.
• Describe team-level execution: training, updated SOPs, monitoring, and escalation paths you introduced.
• Quantify outcomes: compliance achieved, effect on cycle times, customer satisfaction (CSAT), or audit results.
• Reflect on lessons learned and how you improved readiness for future regulatory changes.

What not to say

• Claiming you delegated everything to legal/compliance without describing how you operationalized changes.
• Focusing only on compliance language without explaining impact on team operations or customers.
• Failing to provide measurable results or concrete examples of how you tracked success.
• Suggesting you ignored timelines or allowed service levels to slip without mitigation.

Example answer

“When Ontario introduced updated reporting and documentation requirements for certain disability claims, I led a cross-functional project to implement the change within eight weeks. I worked with compliance to translate legal requirements into a checklist for adjusters, partnered with IT to add the checklist into our claims workflow, and ran three mandatory training sessions for 40 staff with practical case exercises. I set up a daily CWG (control working group) for the first month and weekly dashboards showing checklist completion and time-to-first-decision. We hit full compliance by the deadline, reduced errors on submitted documentation by 60%, and maintained average cycle time within 5% of prior levels. The process also fed into an updated SOP library for future regulatory changes.”

Introduction

This tests technical claims expertise: determining liability, assessing reserves, detecting fraud, coordinating with legal and investigators, and protecting the insurer’s financial exposure—core responsibilities for a claims manager in Canada.

How to answer

• Start by describing initial triage: gather basics (policy, incident report, medical records, police report, witness statements).
• Explain liability assessment: scene facts, timelines, witness credibility, precedents under provincial tort law.
• Detail medical/forensic review: independent medical examinations (IMEs), treating physician notes, objective findings versus subjective complaints.
• Describe fraud red flags and investigative steps: inconsistencies in statements, timing of treatment, social media checks, CCTV or GPS data, prior claim history.
• Outline coordination: when to involve SIU/fraud investigators, external counsel, special investigators, and subrogation teams.
• Discuss reserving and negotiation strategy: establishing initial reserves, setting triggers for escalation, and settlement approaches if liability is clear.
• Mention documentation and compliance: audit trail, privacy and PHIPA/PIPEDA considerations, and reporting to regulators when required.

What not to say

• Relying solely on intuition without describing specific data sources or investigative steps.
• Describing invasive or non-compliant investigative tactics that breach privacy laws.
• Ignoring the need to involve legal counsel or medical experts when appropriate.
• Failing to mention how you'd manage reserving and financial risk during the investigation.

Example answer

“I would begin with a thorough triage: confirm the policy terms, obtain the accident report, medical records and police report, and document all communications. For liability, I'd map timelines and compare witness statements; if facts are ambiguous, I'd commission a scene reconstruction or consult an external expert. For the injury, I'd request treating physician notes and, where appropriate, an IME to verify objective findings. If I see fraud indicators—conflicting histories, unusually rapid escalation of treatment, or social activity inconsistent with claimed limitations—I’d open an SIU referral, order targeted social media and CCTV checks within privacy rules, and involve our fraud investigator. I’d set conservative but defensible reserves and update them as evidence evolves. If third-party liability existed, I’d notify subrogation and coordinate with external counsel. Throughout, I’d keep a clear audit trail and update senior leadership weekly on risk and next steps.”

Introduction

Natural catastrophes and weather events create claim surges. This situational question evaluates triage, resource planning, vendor management, customer communication and people leadership under pressure—key for a Canadian claims manager dealing with multi-province events.

How to answer

• Describe how you'd activate a catastrophe response plan or create one if absent.
• Explain prioritization criteria: safety, emergency mitigation, high-value losses, fraud risk, vulnerable customers (seniors, large businesses).
• Outline resource allocation: surge staffing (internal reassignments, temporary hires, vendor adjusters), shift schedules, and cross-training to handle volume.
• Discuss quality controls: simplified but robust checklists, peer reviews, spot audits, and daily KPIs to monitor accuracy and cycle times.
• Address adjuster wellbeing: reasonable shift patterns, mandatory breaks, mental health supports, and clear delegation to reduce overload.
• Detail communication strategy: proactive customer outreach, expectations for timelines, and coordinated messaging with customer service and media teams.
• Mention post-event review: capture lessons, update SOPs, and rebuild reserves or vendor contracts if necessary.

What not to say

• Saying you would prioritize purely by arrival time rather than severity and risk.
• Assuming existing staff can absorb unlimited volume without discussing surge resources or wellbeing.
• Neglecting to mention communication with customers or cross-functional coordination.
• Overlooking quality assurance measures that prevent costly errors during high volume.

Example answer

“I would immediately stand up the catastrophe response team and implement a Triage-Then-Scale approach. Triage would route urgent, safety-related claims and large commercial losses for immediate response while minor claims go to accelerated digital handling. I’d redeploy experienced adjusters to complex claims and bring in vetted vendor adjusters for straightforward files, pairing vendors with internal mentors for quality control. I’d implement a shortened checklist for initial assessments, run daily KPI dashboards (contact rate, initial visit within X hours, reserve variance), and conduct spot audits to maintain standards. To prevent burnout, I'd stagger shifts, mandate rest periods, and bring in extra HR/occupational support. Proactive customer communications would set realistic timelines and provide mitigation guidance. After the surge, we’d run a lessons-learned workshop and update our catastrophe playbook.”