Quality Control & Assurance Flashcards
7 cards from real Insurance practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Quality Control & Assurance flashcards as text
Which of the following scenarios represents a 'proactive' quality assurance approach in insurance?
Answer: Building automated compliance checks into the claims system before errors occur
Proactive QA prevents errors by embedding controls at the point of decision-making rather than discovering them after the fact.
An insurer's QA program shows a high rate of 'reserve adequacy' errors. This most directly affects:
Answer: The accuracy of the company's financial statements and solvency reporting
Inadequate reserves misstate liabilities on financial statements and can jeopardize an insurer's reported solvency position.
Under ISO 9001 quality management standards, which element is central to a quality management system (QMS)?
Answer: Continuous improvement through the Plan-Do-Check-Act (PDCA) cycle
ISO 9001 is built around the PDCA cycle, which drives ongoing evaluation and improvement of quality processes.
A 'peer review' QA model in insurance means:
Answer: Adjusters review each other's claim files to provide feedback and identify errors
Peer review leverages adjuster expertise by having colleagues evaluate each other's work, promoting knowledge sharing and catching errors.
Which of the following best illustrates 'benchmarking' as a QA tool in insurance?
Answer: Comparing your claims closure rates against industry averages or best-in-class competitors
Benchmarking evaluates performance relative to external standards or competitors, providing context that purely internal metrics cannot.
When a state insurance department issues a 'cease and desist' order related to claims practices, the insurer's QA department's immediate role should be to:
Answer: Conduct an urgent internal audit to identify the scope of non-compliant practices and implement remediation
A cease and desist triggers an immediate internal review to understand where practices failed and enact controls to prevent recurrence.
Which data point would a QA manager most likely monitor to detect potential bad faith claims handling?
Answer: Rate of claims where investigation exceeded statutory response deadlines
Consistently missing statutory response deadlines can constitute bad faith, making deadline compliance a critical QA indicator.