6 Auto Claims Adjuster Interview Questions and Answers

Introduction

Customer-facing communication and de-escalation are core parts of a junior auto claims adjuster's role. This question evaluates your ability to manage emotions, explain coverage clearly, and maintain professionalism while protecting the insurer from inappropriate payouts.

How to answer

• Use the STAR structure: briefly state the Situation and Task, focus on your Actions, and finish with Results.
• Start by describing the claimant's concern and the specific policy ambiguity or coverage question.
• Demonstrate active listening and empathy: explain how you acknowledged the claimant's feelings and gathered all relevant facts.
• Show how you interpreted policy language (consulted a supervisor or policy guideline if needed) and communicated the reasoning in plain English.
• Explain any compromise or next steps you offered (e.g., sending a supplemental estimate, arranging an inspection, escalation to a senior adjuster).
• Quantify the outcome if possible (reduced escalation, resolved within X days, claimant satisfaction) and note lessons learned about communication or documentation.

What not to say

• Claiming you always side with the claimant without referencing policy or evidence.
• Saying you argued or became confrontational with the claimant.
• Failing to mention checking the policy, obtaining facts, or escalating when uncertain.
• Omitting documentation or follow-up steps that protect the company legally.

Example answer

“Situation: At my internship with a regional carrier in Ohio, a claimant insisted his bumper damage after a parking lot incident was fully covered, but the policy had a specific exclusion for cosmetic-only damage. Task: I needed to de-escalate, verify coverage, and resolve the claim fairly. Action: I listened to the claimant's account without interruption and empathized: “I understand why you're frustrated.” I then reviewed the policy, photographed the vehicle, and arranged for an adjuster inspection. Because the inspection showed structural misalignment beyond cosmetic damage, I explained the findings and cited the specific policy wording, offering to waive the deductible as a goodwill gesture while following policy limits. Result: The claimant accepted the explanation, the claim was settled within five business days, and my supervisor commended the thorough documentation and calm communication. I learned to always document conversations and to involve inspections early when coverage is unclear.”

Introduction

This technical competency checks your ability to apply policy terms, assess evidence, use estimating tools, and follow company procedures—essential day-to-day tasks for a junior adjuster.

How to answer

• Outline the step-by-step process: review policy declaration page, coverage limits, deductibles, and endorsements first.
• Describe how you'd examine the evidence: compare photos to the police report and estimate, confirm date/time/location, and look for signs of pre-existing damage.
• Explain use of estimating software (e.g., CCC, Audatex) or company claim systems to validate repair costs and labor rates.
• Describe checks for exclusions (wear-and-tear, pre-existing, certain custom parts) and subrogation or third-party liability possibilities.
• Mention when to order additional documentation: independent inspection, repair shop estimates, or expert opinions.
• Address how you'd calculate payout: allowed repair costs minus deductible, applying policy limits and depreciation if required.
• Note regulatory or company workflow steps: fraud flags, manager approvals for certain thresholds, and timely communication with the claimant.

What not to say

• Relying solely on the claimant's estimate without verifying with photos or inspections.
• Skipping policy review and assuming standard coverage applies.
• Ignoring company systems or not escalating when costs exceed your authority.
• Failing to consider depreciation, salvage, or third-party responsibility when applicable.

Example answer

“First I'd open the policy and confirm coverages, limits, and the deductible on the declarations page. Next, I'd review the police report and photos to confirm the reported accident and check for inconsistencies or prior damage. I'd enter the vehicle and damage details into our estimating tool (for example, CCC) to generate a standardized repair estimate and compare that to the shop estimate. If the estimate exceeds my approval limit or if photos suggest hidden damage, I'd order a physical inspection. I would check for exclusions—such as non-covered customization or pre-existing damage—and determine if depreciation applies. After confirming allowable costs, I'd calculate the payout: approved repair cost minus the deductible (and noting salvage value if totaled). Finally, I'd document every step in the claim system, notify the claimant of the settlement explanation, and route the file for manager approval if required by dollar thresholds or fraud indicators.”

Introduction

This situational question assesses triage, time management, risk assessment, and adherence to procedures—critical when handling high volumes after catastrophic events.

How to answer

• Start by stating triage principles: safety/injury first, regulatory deadlines, fraud indicators, and contractual SLAs.
• Explain how you'd classify claims by severity: immediate injury reports, potential total losses, and high-fraud-risk files.
• Describe specific actions: contact claimants reporting injuries immediately, open SIU or fraud team referrals for suspicious files, and schedule inspections or vendor assignments.
• Show time-blocking and delegation: use pre-authorized vendors, assign straightforward estimates to team members or vendors, and escalate high-impact files to supervisors.
• Address communication: set claimant expectations with estimated timelines and provide self-service portals where possible.
• Mention documentation and compliance: ensure timely First Notice of Loss (FNL) entries, regulatory notifications if required, and maintain audit trails.
• Conclude with how you'd monitor and adjust: daily stand-up with the team, track KPIs (cycle time, claimant callback rate), and re-prioritize as new info arrives.

What not to say

• Treating all claims equally without triage.
• Ignoring potential injuries or fraud indicators to push through volume.
• Saying you'd simply work claims in the order received without delegation.
• Overpromising callers unrealistic timelines.

Example answer

“I would triage immediately: first, contact the five claimants reporting possible injuries to confirm medical needs and advise them on next steps, because claimant safety and potential bodily injury exposures are highest priority. Next, I'd flag the two suspicious high-severity files and escalate them to our Special Investigations Unit while preserving evidence (photos, statements) to avoid contamination. For the backlog of 40 low-severity hail claims, I'd deploy pre-approved glass/repair vendors and batch-assign straightforward inspections, freeing elected team members to handle moderate claims that require more review. Throughout, I'd log FNLs, set up automated status messages so claimants know when to expect contact, and brief my supervisor on resource constraints and any files needing urgent approval. I'd run daily checks on turnaround metrics and shift resources if a file's status changes. This approach balances claimant care, fraud mitigation, and throughput during a high-volume event.”

Introduction

Auto claims adjusters must accurately assess vehicle damage, estimate repair costs, and determine liability. In Brazil, regional repair costs, parts availability, and local regulations (e.g., DETRAN processes) affect valuations, so this question tests technical inspection skills and local context awareness.

How to answer

• Start with a structured on-site approach: secure the scene (if applicable), ensure safety, document photos/videos from multiple angles, and record vehicle and policy details.
• Explain how you determine liability: collect witness statements, police/ocorrência reports, and compare damages with the described accident dynamics.
• Describe damage assessment: identify visible vs. hidden damage, note vehicle model/year, check for previous repairs or aftermarket parts, and estimate repair times and parts needed.
• Show how you derive cost estimates: use local labor rates and part prices (mention regional variations in São Paulo), consult approved repair shops or internal pricing tools, and factor in salvage or total loss thresholds.
• Mention administrative steps: complete the claim file, communicate timelines to the insured, coordinate with workshops (oficinas credenciadas such as those used by Porto Seguro or Bradesco Seguros), and prepare recommendations for payment or subrogation.
• Conclude with quality checks: validate estimates with a senior adjuster or quality control, and document all sources and rationale to support the decision.

What not to say

• Skipping photographic or written documentation and relying on memory.
• Giving an estimate without checking local part availability or labor rates.
• Assuming liability without verifying police reports or witness statements.
• Ignoring signs of prior damage or aftermarket modifications that affect valuation.

Example answer

“First I secure complete documentation: photos of all damage, chassis and plate numbers, driver's statements, and the BO (boletim de ocorrência) if filed. At the scene (or at the workshop), I check for hidden damage by testing systems (airbags, alignment) and inspect structural components. I then build an estimate using our internal pricing tool adjusted for São Paulo labor rates and parts suppliers. If repair cost exceeds the total loss threshold defined in the policy, I calculate indemnity based on market value using comparable listings. I document each decision and contact the insured within 24 hours to explain next steps and preferred workshops. If I suspect negligence or third-party liability, I flag for subrogation and collect additional evidence.”

Introduction

This behavioral question evaluates customer service, negotiation, empathy, and conflict-resolution skills. Adjusters in Brazil frequently interact with insureds who are emotional about vehicle loss or repair delays; handling these interactions professionally preserves trust and reduces escalations.

How to answer

• Use the STAR framework: briefly set the Situation and Task, focus on Actions you took, and end with clear Results.
• Show empathy first: explain how you acknowledged the claimant's feelings and built rapport.
• Detail factual steps: re-check valuation sources, explain how market value was determined, and offer transparent documentation.
• Demonstrate negotiation: describe any compromise proposals (e.g., selecting alternate comparable vehicles, expedited payment, or workshop options).
• Quantify the result when possible: reduced escalation, agreement reached, or faster settlement time.
• Reflect on lessons learned: process improvements or communication changes you implemented afterwards.

What not to say

• Claiming you avoided the confrontation without addressing the claimant’s concerns.
• Taking an adversarial tone or blaming the claimant for being difficult.
• Omitting measurable outcomes or how the situation was resolved.
• Saying you always stick strictly to policy without room for customer-centric judgment.

Example answer

“At a previous role with a regional insurer in Minas Gerais, an insured was furious because our market valuation for his 2015 hatchback was lower than his expectation. I listened and let him explain why the car was special to him, then calmly walked him through how we calculate market value—showing comparables from local listings and the depreciation table we used. I re-checked our sources and found one comparable was incorrectly dated, so I updated the calculation and offered a small goodwill payment to cover transport costs while he sourced a similar vehicle. The claimant accepted, we closed the file the same week, and I suggested our team update the comparable-check step to prevent similar errors. The result: no escalation and improved internal valuation checks.”

Introduction

Detecting and handling suspected fraud is critical to controlling loss ratios. Adjusters must balance thorough investigation with respect for legal constraints and the insured's rights, and coordinate with internal fraud teams and possibly law enforcement.

How to answer

• Start by explaining evidence-gathering: detailed interviews, reviewing the BO, comparing photos, timestamps, and prior policy history.
• Mention use of data tools: cross-checking vehicle history, prior claims, telematics/GPS data if available, and social media or marketplace listings.
• Discuss escalation: when to notify the internal antifraud/fraudes team and the legal department, and how to preserve chain of custody for evidence.
• Explain interactions with the claimant: conduct interviews professionally, document inconsistencies, and avoid accusatory language.
• Cite compliance: follow LGPD (Brazilian data protection law) rules when accessing or storing personal data, and coordinate with external authorities (police) only as advised by legal/fraud teams.
• Describe potential outcomes: denial, referral to investigators, or negotiated settlement, and how you document justification for decisions.

What not to say

• Accusing a claimant outright without evidence or investigation.
• Accessing or sharing personal data without regard for LGPD protections.
• Ignoring internal escalation processes or attempting to handle a complex fraud case alone.
• Withholding documentation or making decisions based on intuition rather than evidence.

Example answer

“If I suspect staged damage, I first compile all factual inconsistencies: compare the insured’s statements to BO timings, analyze photos for tampering or repeated damage patterns, and review the vehicle's claims history. I run data checks—vehicle history and any telematics—and preserve all evidence. I notify our antifraud team and legal counsel, providing a documented timeline and the supporting materials. Per LGPD, I only access and share personal data through approved channels. We then decide whether to interview witnesses, request repair shop invoices, or involve police. In a past case, this process led to uncovering coordinated staged claims; the antifraud team conducted a deeper investigation and the company recovered funds through subrogation while minimizing legal exposure.”

Introduction

Senior auto claims adjusters must accurately determine fault, separate new damage from pre-existing conditions, and produce defensible reserve and settlement estimates. In Mexico, this also often requires understanding local repair markets, parts availability, and compliance with CONDUSEF guidance.

How to answer

• Start with a concise summary of your standard investigation workflow (scene info, photos, witness statements, police reports).
• Explain how you document and differentiate new vs. pre-existing damage (use of timelines, previous repair records, VIN checks).
• Describe estimating methodology: tools/software you use (e.g., CCC, Audatex or local equivalents), parts sourcing, labor rates, and consideration for total loss thresholds.
• Detail how you assess and document causation and liability when multiple vehicles are involved, including use of diagrams and third-party statements.
• Explain quality-control steps to ensure the estimate is defensible (peer review, supervisor sign-off, retention of supporting evidence).
• Mention regulatory and customer-communication aspects relevant to Mexico (timelines for claim acknowledgement, disclosure to policyholders, handling of invoices and receipts).
• End with how you convert investigation findings into a recommended reserve and settlement plan, including negotiation strategy if liability is shared.

What not to say

• Relying solely on visual inspection without corroborating documentation (photos, reports).
• Claiming you can always determine pre-existing damage without expert input or repair history.
• Failing to mention the use of standardized estimating tools or local labor/parts rates.
• Ignoring regulatory timelines or the need to clearly communicate next steps to claimants.

Example answer

“I begin by securing the scene documentation: photos, police report, driver statements and witness contact info. I check the vehicle history and prior repair invoices to identify pre-existing damage. Using Audatex (or a local equivalent) with current Mexican parts and labor databases, I create a line-item estimate and note any items that may require disassembly to confirm. For multi-vehicle impacts, I diagram the collision and document points of contact to support causation. If liability appears shared, I outline percentage splits backed by evidence. I run the estimate through a peer review, set an appropriate reserve reflecting parts lead time and shop capacity in the claimant’s area, and communicate the findings and next steps in Spanish, referencing applicable timelines under CONDUSEF guidance. If total loss is possible, I calculate ACV with comparable local market values and include supporting comps.”

Introduction

Detecting and handling fraud is critical to protect the insurer and ensure fair treatment of honest customers. This behavioral question assesses judgment, attention to detail, ethical decision-making, and knowledge of fraud escalation processes in a Mexican context.

How to answer

• Use the STAR method: set the scene, describe the specific actions you took, and explain the result.
• Start by describing red flags you observed (inconsistent statements, gaps in documentation, suspicious repair shop invoices).
• Explain investigative steps: additional interviews, independent vehicle inspections, contact with prior insurers, use of databases, or working with a fraud unit or investigator.
• Describe how you maintained fairness and compliance (documenting findings, protecting claimant privacy, consulting legal or compliance teams when needed).
• Conclude with the outcome (recovery, denial, referral to fraud unit, improvements to processes) and what you learned.

What not to say

• Accusing a claimant without evidence or due process.
• Saying you ignored company procedure or skipped escalation steps.
• Focusing only on catching fraud rather than documenting and following legal/regulatory steps.
• Claiming you always identify fraud without acknowledging complexity or false positives.

Example answer

“At my previous role in Mexico City, I noticed a claimant’s invoice totals were much higher than local shop averages and photos showed aftermarket parts inconsistent with the vehicle model. I requested a secondary inspection by an independent appraiser and cross-checked prior claims history and the repair shop’s reputation. The independent inspection confirmed some items had pre-existing damage that were being re-billed as new. I documented all evidence, involved our internal fraud unit, and coordinated with legal to deny the fraudulent portions while paying for verified damage. We recovered a portion of the payment and updated our red-flag checklist for field adjusters. The case reinforced the importance of impartial verification and careful documentation.”

Introduction

Senior adjusters must manage escalations, de-escalate upset customers, and coordinate with repair networks while protecting the insurer’s reputation and complying with Mexican consumer protection expectations.

How to answer

• Start by explaining how you'd acknowledge the claimant’s concerns and show empathy in Spanish, validating their frustration.
• Describe immediate fact-finding steps: confirm repair status with the shop, check part availability, and review prior communications and timeline estimates.
• Explain communication strategy: provide a clear, transparent update with revised timelines, explain reasons for delay (e.g., parts backorder), and offer interim solutions (rental car extension, alternative shops, direct repair).
• Mention escalation protocols: when to involve a supervisor, legal, or the CONDUSEF liaison, and how to document all interactions.
• Discuss prevention: process improvements you might recommend (better shop SLAs, proactive status updates, improved expectations at first contact).
• Emphasize maintaining professional tone, keeping written records in Spanish, and following company policy for reimbursements or goodwill gestures if appropriate.

What not to say

• Telling the claimant to calm down or dismissing their complaint.
• Making promises you can’t keep (immediate fixes without confirmation).
• Failing to document the interaction or to coordinate with repair partners.
• Escalating to legal or CONDUSEF prematurely without attempting resolution.

Example answer

“First, I would acknowledge the claimant’s frustration in Spanish and apologize for the inconvenience. I would immediately contact the repair shop to get a precise status update and confirm whether delays are due to parts, labor backlog, or authorization issues. I would then call the claimant to provide a clear explanation and revised completion date, and offer a rental extension or a referral to an alternative certified shop if that reduces their downtime. I would document the call and follow up with an email in Spanish summarizing next steps. If the claimant still threatens CONDUSEF escalation, I would inform them of the formal complaint process and proactively loop in our customer relations and legal teams to ensure we comply with consumer protection rules and resolve the matter quickly. After resolution, I’d recommend operational changes like proactive 48-hour status updates from partner shops to prevent repeat issues.”

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 Japan must balance excellent customer service, regulatory compliance, and cost control. This question evaluates your negotiation, judgement, and stakeholder-management skills when a claim risks escalation.

How to answer

• Use the STAR structure: Situation, Task, Action, Result.
• Start by briefly describing the background: type of policy, claimant profile, and why the dispute arose.
• Explain your responsibilities and constraints (company policy, JFSA/regulatory considerations, litigation risk).
• Detail concrete actions you took: fact-finding, communicating with the claimant, involving legal or underwriting, offering settlements or mediation, and documenting decisions.
• Quantify the outcome where possible (reduction in claim cost, avoided litigation, improved customer satisfaction).
• Reflect on what you learned and any process changes you introduced to prevent recurrence.

What not to say

• Claiming you resolved it solely by bending rules or without consulting compliance/legal.
• Focusing only on empathizing with the claimant and ignoring company/regulatory constraints.
• Taking all credit and omitting team or cross-department involvement.
• Giving a vague story with no measurable result or concrete steps.

Example answer

“At Sompo Japan, a commercial property claimant threatened legal action after a denied partial payment due to suspected overstatement of damages. I led a review: re-checked surveyor reports, requested additional invoices, and coordinated with our legal team to assess liability exposure under the policy terms. I arranged a mediated phone meeting with the claimant, clearly explained the evidence and our calculation, and offered a goodwill payment tied to a release clause to avoid litigation. The claimant accepted, litigation was avoided, and we reduced projected payout by ¥1.8 million compared with their initial demand. Afterwards, I updated our triage checklist to ensure earlier documentation collection on similar cases.”

Introduction

This situational/technical question assesses your ability to detect fraud, follow compliant investigation procedures, protect company financials, and manage customer expectations — all critical for a Claims Supervisor in Japan where fraud is handled carefully and with legal implications.

How to answer

• Outline an organized, step-by-step investigation plan emphasizing compliance with internal fraud protocols and Japanese law.
• Mention immediate risk controls: pausing payment authorization, flagging the file, and notifying anti-fraud or legal teams as per company policy.
• Describe evidence collection: independent vehicle inspection, medical records validation, witness statements, telematics/GPS or CCTV where applicable.
• Explain coordination with internal partners (fraud investigators, legal, underwriting) and external parties (police, certified garages, medical institutions) while respecting privacy laws.
• Address communication: how you'll inform the claimant about timelines without admitting liability and manage expectations.
• State decision criteria: thresholds for escalation, when to pay, when to deny, and documentation required for each outcome.
• Include post-resolution steps: lessons learned, reporting to management, and process improvements to reduce similar fraud risk.

What not to say

• Paying quickly to avoid complaint without investigating fraud signs.
• Ignoring data privacy or failing to involve legal when appropriate.
• Relying solely on gut feeling rather than documented evidence and procedure.
• Delaying communication entirely, leaving claimant uninformed.

Example answer

“First I would place a temporary hold on any payment authorization and flag the file per MS&AD’s anti-fraud protocol. I’d assemble a mini-investigation team: an internal fraud analyst, an external independent garage, and legal counsel. We’d request additional documentation (detailed repair invoices, dated photos, CCTV/drive recorder data) and interview witnesses. While investigation proceeds, I’d send the claimant a clear, polite update in Japanese explaining we’re verifying details and provide an expected timeframe. If evidence confirms staged damage, I’d deny the fraudulent portion, coordinate with legal and police for potential prosecution, and document everything. If the investigation shows portions are valid, we’d process legitimate elements promptly. After closing, I’d run a case debrief and propose a rule addition to our FNOL checklist to capture the specific red flags that appeared in this case.”

Introduction

As a Claims Supervisor in Japan, effective people management and continuous process improvement are essential to meet SLAs and customer expectations. This competency/leadership question probes your coaching, KPI management, and change leadership skills.

How to answer

• Describe your approach to setting clear performance expectations and measurable KPIs (TAT, accuracy rate, customer satisfaction scores).
• Explain how you use data to identify training needs and bottlenecks (quality audits, root-cause analysis).
• Share specific coaching or training initiatives you’ve implemented (peer reviews, skill workshops, on-the-job shadowing).
• Mention motivation strategies suited to Japanese workplace culture: recognition, career-path clarity, team-based goals, and respectful feedback.
• Discuss how you balance speed with accuracy and regulatory compliance, including quality control checks.
• Provide examples of measurable outcomes from your leadership (reduced cycle time, improved accuracy, higher NPS).

What not to say

• Saying you pressure staff to work faster without supporting training or quality checks.
• Relying only on monetary incentives without addressing intrinsic motivation or career development.
• Ignoring cultural norms around feedback and team harmony in Japan.
• Claiming improvements without backing them with metrics or examples.

Example answer

“I set transparent KPIs: average TAT, first-time accuracy, and claimant satisfaction. Using our claims dashboard, I identified that approvals were delayed at the medical-verification step. I implemented targeted training for that sub-team, introduced a peer-review system to catch errors before finalization, and held monthly huddle meetings to share difficult cases and celebrate wins. I also introduced a 'Customer Care Award' to recognize staff who received high claimant feedback, which boosted morale. Over six months, we reduced average TAT by 20%, increased accuracy from 92% to 97%, and improved CSAT by 8 points. I maintain these gains by regular coaching and reviewing process KPIs with the team.”

Introduction

Claims managers in China’s insurance market must detect fraud early to protect loss ratios and regulatory compliance. This question assesses your investigative skills, judgment, and ability to coordinate with underwriting, legal, and compliance teams.

How to answer

• Use the STAR structure: briefly set the Situation and Task, then focus on the Actions you took and the Results achieved.
• Describe the red flags or data that led you to suspect fraud (e.g., inconsistent statements, claim timing, medical records, suspicious patterns across policies).
• Explain your investigative approach: data gathering, interviews, liaison with underwriting/forensics/third-party investigators, and use of analytics or case management tools.
• Detail how you ensured regulatory and internal policy compliance while protecting claimant rights.
• Quantify the outcome where possible (amounts saved, number of fraudulent claims prevented, time to resolution) and mention lessons learned and process improvements implemented.

What not to say

• Claiming decisive actions without consulting legal or compliance — implying you bypassed required procedures.
• Focusing only on accusation without describing how you validated evidence objectively.
• Taking sole credit and failing to acknowledge collaboration with other teams.
• Being vague about outcomes or unable to explain how the incident changed processes to reduce recurrence.

Example answer

“At Ping An, I noticed a cluster of auto claims from the same repair shop with unusually similar invoices. I opened a case, pulled historical claim data, and worked with our fraud analytics team to identify matching patterns. I coordinated interviews with the claimants, engaged legal for subpoena of repair records, and involved the underwriting team to check policy histories. Our investigation confirmed staged accidents; we denied six fraudulent claims, recovered part of the payouts through recovery actions, and updated our detection rules to flag the repair shop and similar invoice signatures. This reduced related suspicious claims by 70% in the next six months and improved our cross-department fraud workflow.”

Introduction

Claims managers must plan and lead operational responses to surges (e.g., typhoon, flood). This evaluates crisis management, resource allocation, stakeholder communication, and ability to maintain service quality under pressure.

How to answer

• Outline immediate priorities: safety of staff/claimants, triage of high-severity claims, and rapid customer communication.
• Describe how you'd scale operations: temporary staffing, shift rotations, reallocating experienced adjusters, and using centralized vs. decentralized handling.
• Explain how you'd coordinate with partners: local branches, third-party adjusters, repair vendors, and regulatory bodies to expedite assessments and payouts.
• Mention metrics to monitor (turnaround time, customer satisfaction, leakage, fraud rate) and how you'd maintain quality controls.
• Include communication plans for internal stakeholders (senior management, underwriting, finance) and external stakeholders (policyholders, regulators, media).
• Discuss contingency planning and post-incident review to capture improvements.

What not to say

• Saying you would process everything on a first-come-first-served basis without triage or prioritization.
• Ignoring staff wellbeing or failing to plan for shift fatigue and burnout.
• Overpromising rapid payouts without addressing fraud controls or operational capacity.
• Failing to measure or report critical KPIs during the surge.

Example answer

“In a previous role at a regional insurer, a severe flood impacted three provinces. I immediately stood up an incident response team, triaged claims by severity and vulnerability (elderly, critical infrastructure), and redeployed senior adjusters to complex cases while hiring contract adjusters for volume work. We set up mobile claims desks in affected cities and engaged vetted third-party repair partners. I instituted daily briefings with operations, finance, and PR to keep leadership informed and set clear customer communication templates. We tracked average days-to-first-contact and settlement leakage daily; within two weeks we reduced backlog by 60% while maintaining claimant NPS above our target. After the event, I led a lessons-learned workshop and revised our disaster SOPs and vendor panels to improve future response times.”

Introduction

Interviewers want to know whether your motivations align with the company’s mission and whether you’ll stay and grow. For a claims manager, motivations related to customer fairness, operational excellence, and risk control are particularly relevant.

How to answer

• Be specific about what aspects of claims management energize you (e.g., helping customers recover, improving processes, detecting and preventing fraud).
• Link your motivation to the context in China (rapid digital transformation, regulatory focus on customer protection, scale of claims operations).
• Show how the role aligns with your medium- and long-term goals (developing technical expertise, moving into operations leadership, or improving customer experience).
• Mention concrete steps you’ve taken to pursue those goals (training, certifications, projects).
• Demonstrate cultural fit by referencing collaboration, respect for regulation, and customer-first orientation.

What not to say

• Giving generic answers like 'I like insurance' without specifics.
• Focusing solely on compensation, title, or short-term perks.
• Suggesting you plan to leave the function quickly for an unrelated career path.
• Claiming you dislike routine or process work if the role requires operational rigor.

Example answer

“I’m motivated by setting fair, efficient claims outcomes that restore customers’ lives after loss—this aligns with the recent regulatory emphasis in China on customer protection. I enjoy solving operational challenges and using data to reduce cycle times and leakage. Over the past three years I completed company-sponsored trainings on claims analytics and led a project to implement mobile claims intake that improved first-contact times by 40%. In the next five years I aim to grow into a head-of-claims role where I can combine process excellence and digital tools to scale high-quality service across regions. That long-term orientation is why I’m excited about a claims manager role at a large insurer like China Life or Ping An.”