Adam manages a claims department for an insurer. He measures the department's
performance by best practices, claims audits, customer satisfaction data, and loss
ratio. Which one of Adam's measures refers to a system of identified internal practices
that claims representatives perform to produce superior performance?
A. Claims audits
B. Best practices
C. Loss ratio
D. Customer satisfaction data
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B. Best practices
Best practices generally refers to a system of identified internal practices
that are shared with claims reps and produce superior performance.
,If the decision on a claim settlement is negative, as in a denial, good-faith claims
handling requires the claims rep to
Select one:
A. Explain the rationale behind the decision to the claimant.
B. Have a supervisor sign off on the communication to the claimant.
C. Deliver the decision to the claimant in writing.
D. Deliver a hard copy of the decision to the claimant by mail.
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A. Explain the rationale behind the decision to the claimant.
Correct. If the decision on a claim settlement is negative, good-faith claims
handling requires the claims rep to explain the rationale behind the
decision.
Bettina's apartment is burglarized and several items are stolen. In filing her claim, she
tells her insurer that her stolen television was both newer and larger than it actually
was. This constitutes which one of the following types of fraud?
Select one:
A. Soft fraud
B. Concealment
C. False claim
D. Misrepresentation
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A. Soft fraud
Correct. In soft fraud, a legitimate loss occurs but the value of that loss is
exaggerated.
, Millstone Insurance wanted to assign its most complex workers compensation claims
to experienced claim adjusters as early as possible. The data science team used the
classification tree technique to develop a predictive model. When holdout data was
used to test the model's predictive accuracy, 45% of the complex claims were
assigned to experienced adjusters. When claims were randomly assigned, only 15% of
the complex claims were assigned to experienced adjusters. What is the lift provided
by the predictive model?
Select one:
A. 0.333
B. 3
C. 30
D. 45
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B. 3
Correct. The lift provided by the predictive model is 3. The lift is calculated
by dividing the model percentage by the nonmodel percentage. (45/15 = 3)
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. State the damages sought
B. Suggest an out-of-court settlement.
C. Identify the opposing attorney(s).
D. Specify a delivery method for the response.
Give this one a try later!
performance by best practices, claims audits, customer satisfaction data, and loss
ratio. Which one of Adam's measures refers to a system of identified internal practices
that claims representatives perform to produce superior performance?
A. Claims audits
B. Best practices
C. Loss ratio
D. Customer satisfaction data
Give this one a try later!
B. Best practices
Best practices generally refers to a system of identified internal practices
that are shared with claims reps and produce superior performance.
,If the decision on a claim settlement is negative, as in a denial, good-faith claims
handling requires the claims rep to
Select one:
A. Explain the rationale behind the decision to the claimant.
B. Have a supervisor sign off on the communication to the claimant.
C. Deliver the decision to the claimant in writing.
D. Deliver a hard copy of the decision to the claimant by mail.
Give this one a try later!
A. Explain the rationale behind the decision to the claimant.
Correct. If the decision on a claim settlement is negative, good-faith claims
handling requires the claims rep to explain the rationale behind the
decision.
Bettina's apartment is burglarized and several items are stolen. In filing her claim, she
tells her insurer that her stolen television was both newer and larger than it actually
was. This constitutes which one of the following types of fraud?
Select one:
A. Soft fraud
B. Concealment
C. False claim
D. Misrepresentation
Give this one a try later!
A. Soft fraud
Correct. In soft fraud, a legitimate loss occurs but the value of that loss is
exaggerated.
, Millstone Insurance wanted to assign its most complex workers compensation claims
to experienced claim adjusters as early as possible. The data science team used the
classification tree technique to develop a predictive model. When holdout data was
used to test the model's predictive accuracy, 45% of the complex claims were
assigned to experienced adjusters. When claims were randomly assigned, only 15% of
the complex claims were assigned to experienced adjusters. What is the lift provided
by the predictive model?
Select one:
A. 0.333
B. 3
C. 30
D. 45
Give this one a try later!
B. 3
Correct. The lift provided by the predictive model is 3. The lift is calculated
by dividing the model percentage by the nonmodel percentage. (45/15 = 3)
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. State the damages sought
B. Suggest an out-of-court settlement.
C. Identify the opposing attorney(s).
D. Specify a delivery method for the response.
Give this one a try later!
