AIC Quality Assurance & Improvement 5

Question 1

A claims department sets a goal of contacting every insured within 24 hours of a reported loss. What type of standard is this?

Accepted Answer

Service-level or timeliness standard

Answer

A contact-within-24-hours goal is a timeliness service standard for claim handling.

Question 2

Which control best prevents an adjuster from settling claims beyond their competence or the insurer's risk tolerance?

Accepted Answer

Settlement authority limits with escalation requirements

Answer

Authority limits require larger or riskier settlements to be approved by more experienced staff.

Question 3

A quality review shows one adjuster's average liability settlements are much higher than peers on similar claims. What is the most appropriate next step?

Accepted Answer

Review the files to determine whether the variance reflects claim facts or handling issues

Answer

Outliers should be investigated to see whether the facts justify them before taking action.

Question 4

Which is a key benefit of using a standardized audit scoring form across all reviewers?

Accepted Answer

Consistent, comparable results across adjusters and offices

Answer

A standardized form ensures every file is judged on the same criteria so results can be compared.

Question 5

Special investigation unit (SIU) referral rates are tracked in a quality program primarily to evaluate what?

Accepted Answer

Whether adjusters properly identify and refer suspected fraud

Answer

Tracking SIU referrals shows whether adjusters recognize fraud indicators and follow referral procedures.

AIC - Associate in Claims Practice Test

AIC - Associate in Claims Practice Test

AIC Quality Assurance & Improvement 5