CA Project Management & Workflow 2 — Questions and Answers
Question 1: When an adjuster receives a high-volume catastrophe assignment, what is the FIRST workflow step?
- Begin inspecting the highest-value losses immediately
- Triage incoming claims by severity and coverage type (Correct answer)
- Contact all claimants simultaneously
- Submit a preliminary estimate to management
Correct answer: Triage incoming claims by severity and coverage type
Triage allows adjusters to prioritize critical losses and allocate time efficiently during catastrophe events.
Question 2: Which project management technique helps an adjuster visualize overlapping tasks and deadlines across multiple open claims?
- PERT chart
- Gantt chart (Correct answer)
- Fishbone diagram
- Critical path matrix
Correct answer: Gantt chart
A Gantt chart displays tasks on a timeline, making it easy to see parallel activities and key deadlines.
Question 3: An adjuster's investigation reveals a potential subrogation opportunity. What workflow action should follow immediately?
- Close the claim after payment
- Notify the insured's attorney
- Preserve evidence and document the third-party liability basis (Correct answer)
- Request a coverage denial
Correct answer: Preserve evidence and document the third-party liability basis
Early evidence preservation protects the insurer's right to recover from liable third parties.
Question 4: Under California claims regulations, what is the maximum number of days an insurer has to acknowledge receipt of a claim?
- 5 days
- 10 days
- 15 days (Correct answer)
- 30 days
Correct answer: 15 days
California Insurance Code regulations require acknowledgment of a claim within 15 days of receipt.
Question 5: An adjuster manages 60 open claims. Which metric best indicates that the workload is unmanageable?
- Average claim age exceeds 45 days (Correct answer)
- More than 10 claims require litigation
- Reserve adequacy is above 95%
- Cycle time per claim drops below 20 days
Correct answer: Average claim age exceeds 45 days
Excessive average claim age signals that files are aging beyond acceptable resolution windows, indicating overload.
Question 6: What does 'round-tripping' refer to in claims workflow management?
- Sending a claim back and forth between departments without resolution (Correct answer)
- Conducting a second field inspection after the first
- Issuing a payment and then reversing it
- Transferring a claim between adjusters twice
Correct answer: Sending a claim back and forth between departments without resolution
Round-tripping wastes time and resources; workflow design should minimize unnecessary handoffs.
Question 7: Which of the following best describes a 'closed with payment' versus a 'closed without payment' claim disposition?
- Both indicate a coverage denial
- Closed with payment means the claim was settled; closed without payment means no covered loss was found (Correct answer)
- Closed without payment always indicates fraud
- Closed with payment applies only to liability claims
Correct answer: Closed with payment means the claim was settled; closed without payment means no covered loss was found
These two dispositions are standard workflow outcomes distinguishing covered losses from non-covered or invalid claims.
CA Project Management & Workflow 2
When an adjuster receives a high-volume catastrophe assignment, what is the FIRST workflow step?