AIC 300 (230 QUESTIONS) ANSWERED
CORRECTLY TO SCORE A+
Which one of the following is a data mining technique an insurer applies when it knows
what - Answer-Classification
Hanna is in IT and works on data analytics projects for an insurer. These projects
involve analyzing large amounts of data to help underwriting to select risks and price
policies. Hanna knows that collaboration between data science, IT, underwriting, and
actuary is critical to the success of these projects. In Hanna's experience, as soon as
the need for a data project arises, the key to collaborating effectively is to engage which
one of the following teams as soon as possible? - Answer-Data science
Greatview Insurance wants to predict which auto liability claims will most likely go to
litigation, so it can assign them to experienced adjusters early in the process. There are
certain known indicators of litigation that Greatview wants to use in the data mining
process. Which one of the following data mining techniques would Greatview's analyst
most likely use? - Answer-Classification
The first step in the data mining process is to - Answer-Understand what a business
wants to achieve
Carla is investigating a claim for a stolen car. The insured provided a copy of the police
report, but she notices that the account in the police report differs from the insured's
version of events. At this point, Carla should - Answer-Continue with her investigation
Benjamin is with the SIU department of an insurer. His company developed technology
to identify patterns related to fraudulent claims activity. He is using a program to analyze
claims data to identify similarities or connections that might indicate fraud. Benjamin is
utilizing - Answer-Data mining
Soft fraud occurs when a claim is exaggerated and is also referred to as - Answer-
Opportunity fraud
As a claims representative, Beatrice is on the front lines for protecting her employer
from insurance fraud. Beatrice should understand that insurance fraud - Answer-Costs
roughly $40 billion per year, excluding health insurance
Larissa is an auto claim adjuster. Traditionally, she has relied on police reports and
witness testimony in her decision making. Recent technological developments give her
access to the driver's driving habits, including acceleration, speed, and braking. This
data available to Larissa is known as - Answer-Telematics
,Soft fraud, also called opportunity fraud, occurs when - Answer-A legitimate claim is
exaggerated
Which one of the following best describes the term 'professionalism' as it relates to
claims professionals? - Answer-The behaviors necessary to implement an ethical
decision
One of Julio's expectations as a claims representative is good-faith claims handling. He
keeps insureds informed about the claim because they have that expectation and
because they are most likely to make a complaint about bad-faith claim handling. He
also wishes to participate in the defense and in discussions about the possibility of
settlement. For these reasons, Julio - Answer-Maintains regular and prompt
communication
For an excess liability claim to be filed, a final judgment or settlement must have been
entered against the insured, and - Answer-The amount of the judgment must be in
excess of the insured's policy limit
Tobias is a claims representative who understands the importance of good-faith claims
handling, including fair evaluation, good-faith negotiation, complete and accurate
documentation, and timely contact with all parties to a claim. Which one of Tobias'
good-faith claims handling practices helps his employer because the parties will be
more likely to remember details of the loss accurately? - Answer-Timely contact with all
parties to a claim
Which one of the following statements regarding state versions of the NAIC model act is
correct? - Answer-Some states allow insureds and claimants to bring lawsuits against
insurers, while others allow only insureds
Not long after Valteri issued a denial and closed the claim, the insured sued for
coverage and alleged bad-faith claim handling against the insurer. Valteri was able to
demonstrate for his superiors that he had made a good-faith investigation and
determined that the claim was not covered by the policy. The insurer maintains that
Valteri had reasonable justification in fact for denying the claim. The insurer is
employing the - Answer-Debatable reasonable basis defense
Ella sued her insurer and alleged bad-faith claim handling after the insurer settled a
claim against her that Ella thought should have been denied. As a result of the
settlement, Ella's premium increased. In her suit, Ella claimed that the insurer rushed
the investigation and did not take all of her facts into consideration in her defense. While
the court found that Ella's argument had merit, it did not award her the full value
because it found that Ella had not provided her information to the insurer in a timely
manner. The insurer used the defense of - Answer-Comparative negligence
An insurer has received a claim related to an accident involving a hoverboard, and an
investigation is needed to process the claim. However, the company doesn't have any
, claims representatives who are knowledgeable about handling hoverboard claims. What
type of claims professional should the company hire to help with this investigation? -
Answer-Independent adjuster
Natalie is a claims representative attempting to settle a complex claim for an insured.
Unfortunately, the insured is dissatisfied with the way settlement negotiations are
progressing. Whom might the insured hire to make sure that his interests are protected?
- Answer-Public adjuster
Leila was recently hired as a claims representative for an insurer. How will Leila help
underwriters, and how will underwriters rely on Leila? - Answer-It helps underwriters by
ensuring that claims are paid fairly and according to their respective policy. The Claims
Department relies on underwriters for thorough, accurate data about the circumstances
under which coverage was written
As a claims representative, who might Geoffrey collaborate with in addition to other
employees of the insurer? - Answer-Geoffrey might collaborate with an expert to
evaluate the cause or value of a loss, investigate the possibility of fraud by an insured or
a third-party claimant, or provide legal advice.
What sets the tone for the claims adjustment process? - Answer-Claims rep's initial
contact with the insure
When do claims reps have the greatest opportunity to positively influence others? -
Answer-During catastrophes, when their help is needed most
What are a loss ratio and a loss adjustment expense (LAE)? - Answer-A loss ratio is a
ratio that measures losses and loss adjustment expenses against earned premiums and
that reflects the percentage of premiums being consumed by losses. LAE is the
expense that an insurer incurs to investigate, defend, and settle claims according to the
terms specified in the insurance policy.
An insurer's management team is evaluating the organization's financial wellbeing and
wants to determine whether the Claims Department is functioning properly, whether the
Underwriting Department is selecting appropriate loss exposures, and whether the
Actuarial Department is pricing the insurance products correctly. What is the profitability
measure that can help management make these determinations? - Answer-The loss
ratio can help the management team make these determinations. The loss ratio
compares an insurer's losses and LAE to its collected premiums and reveals the
percentage of premiums being consumed by losses.
What is the first activity in the claims handling process? - Answer-Acknowledging
receipt of the claim
What must a claims representative determine after confirming that a policy was in force
on the date of the loss? - Answer-Whether the loss occurred within the policy period,
