Insurance Quality Control & Assurance 5

Question 1

Which of the following scenarios represents a 'proactive' quality assurance approach in insurance?

Accepted Answer

Building automated compliance checks into the claims system before errors occur

Answer

Proactive QA prevents errors by embedding controls at the point of decision-making rather than discovering them after the fact.

Question 2

An insurer's QA program shows a high rate of 'reserve adequacy' errors. This most directly affects:

Accepted Answer

The accuracy of the company's financial statements and solvency reporting

Answer

Inadequate reserves misstate liabilities on financial statements and can jeopardize an insurer's reported solvency position.

Question 3

Under ISO 9001 quality management standards, which element is central to a quality management system (QMS)?

Accepted Answer

Continuous improvement through the Plan-Do-Check-Act (PDCA) cycle

Answer

ISO 9001 is built around the PDCA cycle, which drives ongoing evaluation and improvement of quality processes.

Question 4

A 'peer review' QA model in insurance means:

Accepted Answer

Adjusters review each other's claim files to provide feedback and identify errors

Answer

Peer review leverages adjuster expertise by having colleagues evaluate each other's work, promoting knowledge sharing and catching errors.

Question 5

Which of the following best illustrates 'benchmarking' as a QA tool in insurance?

Accepted Answer

Comparing your claims closure rates against industry averages or best-in-class competitors

Answer

Benchmarking evaluates performance relative to external standards or competitors, providing context that purely internal metrics cannot.

Insurance Practice Test