AIC 300 CLAIMS IN AN EVOLVING WORLD TEST QUESTIONS WITH CORRECT ANSWERS
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AIC 300 CLAIMS IN AN EVOLVING WORLD
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AIC 300 CLAIMS IN AN EVOLVING WORLD
AIC 300 CLAIMS IN AN EVOLVING WORLD TEST QUESTIONS WITH CORRECT ANSWERS
Ciara is going to college with the goal of working as a data scientist for an insurer. She will need a strong foundation in mathematics and statistics, computer programming, domain knowledge, and data science. Which one of Ci...
AIC 300 CLAIMS IN AN EVOLVING WORLD
TEST QUESTIONS WITH CORRECT
ANSWERS
Ciara is going to college with the goal of working as a data scientist for an insurer. She
will need a strong foundation in mathematics and statistics, computer programming,
domain knowledge, and data science. Which one of Ciara's skills will require her to
understand the insurance profession to which the data is being applied?
Select one:
A. Mathematics and statistics
B. Data science.
C. Domain knowledge
D. Computer programming - Answer-C. Domain knowledge
Domain knowledge is the understanding of the discipline, profession, or activity to which
the data is being applied.
Which one of the following methods of establishing case reserves involves a consensus
among multiple claims reps?
Select one:
A. Expert system method
B. Average value method
C. Roundtable method
D. Formula method - Answer-C. Roundtable method
With the roundtable method, a consensus reserve figure may be reached following
evaluation and discussion among claims reps.
Which one of the following can be applied over time to refine a model to better predict
results?
Select one:
A. Association rule learning
B. Statistics
C. Regression
D. Machine learning - Answer-D. Machine learning
An insurer that finds it economically impractical to establish a claims office in a given
state is likely to use which one of the following to perform the claims handling function?
Select one:
A. Producers
B. Third-party administrators
C. Public adjusters
D. Independent adjusters - Answer-D. Independent adjusters
,Insurers may contract with independent adjusters to handle claims in strategic locations.
Joy Insurance Company is interested in using data mining to solve a problem it is
having with claims fraud in one of its product lines. The first step it should take is
Select one:
A. To understand what it wants to achieve.
B. To develop a model to analyze the data.
C. To prepare the data by cleaning it.
D. To understand the types of data to use. - Answer-A. To understand what it wants to
achieve.
Jose is handling a workers compensation claim. The injured worker claims to have
strained his back when he lifted a box at work. He waited a day to report the injury
because he thought he would be okay. He asked Jose when he would be referred to a
back specialist and when he could expect his first check. Which one of the injured
worker's actions would be the most pertinent fraud indicator to Jose?
Select one:
A. Asking for referral
B. Lifting a box
C. Waiting to report
D. Asking about check - Answer-A. Asking for referral
Asked for referral could indicate that the worker has knowledge of the workers
compensation system because he had been through it before.
Daniel is a claims supervisor. One of his responsibilities is to review claim files to
monitor the performance of the adjusters and to provide guidance. He also realizes that
claims department peers review files as part of roundtable discussions and that state
insurance department representatives might review files as part of market conduct
studies. For these reasons, Daniel makes sure his direct reports
Select one:
A. Maintain complete and accurate documentation.
B. Provide competent legal advice.
C. Make fair evaluations.
D. Conduct good-faith negotiations. - Answer-A. Maintain complete and accurate
documentation.
Maintain complete and accurate documentation. A claim file must contain a complete
and accurate account of the claims rep's activities and actions.
Leila is conducting a claims investigation and is taking a recorded statement from the
claimant. She wants a simple yes-or-no answer to prevent the interviewee from
explaining the answer further. She asks, "You experienced back pain immediately when
you lifted the box, didn't you?" Leila has asked a(n)
Select one:
A. Direct question.
, B. Indirect question.
C. Open-ended question.
D. Leading question. - Answer-D. Leading question.
Claims rep Miguel is conducting a settlement with a claimant. He constructs his first
offer so that the claimant will likely find it undesirable. This becomes the basis of
comparison for the second offer that he makes. Miguel understands that people
Select one:
A. Feel empowered when given a choice.
B. Will typically accept a second offer.
C. Are naturally suspicious of an initial offer.
D. Are easier to manipulate with choices. - Answer-A. Feel empowered when given a
choice.
Which one of the following terms encompasses types of fraud including false claims and
intentional losses?
Select one:
A. Willful fraud
B. Staged fraud
C. Soft fraud
D. Hard fraud - Answer-D. Hard fraud
Which one of the following statements regarding subrogation is most accurate?
Select one:
A. Most policies require the insured to cooperate with the insurer in recovering payment
through subrogation, to include testifying or appearing in court.
B. The insured typically must cooperate with the insurer in recovering payment through
subrogation, but is not required to testify or appear in court.
C. The insured is typically under no obligation to cooperate with the insurer in
recovering payment through subrogation.
D. All policies require the insured to cooperate with the insurer in recovering payment
through subrogation. - Answer-A. Most policies require the insured to cooperate with the
insurer in recovering payment through subrogation, to include testifying or appearing in
court.
The allegations contained in a summons and complaint typically serve four purposes:
To give notice, reveal facts, formulate legal causes of action and
Select one:
A. Suggest an out-of-court settlement.
B. Specify a delivery method for the response.
C. Identify the opposing attorney(s).
D. State the damages sought. - Answer-D. State the damages sought.
The allegations contained in a summons and complaint typically give notice, reveal
facts, formulate legal causes of action and state the damages sought.
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