Which one of the following terms encompasses types of fraud including false claims
and intentional losses?
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Hard fraud
Statute of limitations
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A law that stipulates the length of time after an even during which legal
proceedings (such as a lawsuit or criminal charges may be initiated
,Claims rep Lily is negotiating a claim settlement with an unrepresented claimant and
wishes to smooth the process. She is matching her demeanor, tone, and mannerisms
to those of the claimant. Lily is using which one of the following negotiation
techniques?
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Using traditional sales techniques
The first step in the data mining process is to
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Understand what a business wants to achieve
Claims representative
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A person responsible for investigating, evaluating, and settling claims
Soft fraud, or opportunity fraud
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, Fraud that occurs when a legitimate claim is exaggerated
Part of the continuous cycle of data mining is preparing the data to eliminate missing
or inaccurate information. This process is called
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Cleaning
Before making initial contact with an insured or claimant, a claims representative
should
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Prepare a list of questions for the insured
Machine learning
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Artificial intelligence in which computers continually teach themselves to
make better decisions based on previous results and new data
Which one of the following statements regarding subrogation is most accurate?
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, Most policies require the insured to cooperate with the insurer in
recovering payment through subrogation, to include testifying or
appearing in court.
One of Juan's responsibilities as a claims representative is to prepare internal reports,
such as preliminary, interim, large loss, and captioned. Which one of the reports Juan
prepares is required for claims with reserves that exceed a specified threshold?
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Large loss
Max is a claims rep conducting a complicated claim investigation. How can he ensure
that he's established the foundation for handling the claim in good faith?
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Max will know if he practiced good-faith claim handling if the claim
investigation is: • Timely—Prompt contact reassures insureds and claimants
that their claims are important and makes them less likely to accept the
advice of others, who may encourage them to retain a lawyer or pursue
unnecessary litigation. • Thorough—He should collect all relevant and
necessary evidence for as long as new facts develop or become available.
• Unbiased—Claims reps should make decisions only after gathering
sufficient information, remaining alert for new information that may change
the course of the claim.
Through data mining, Goshen Mutual discovers that customers who insure two or
more vehicles on a personal auto policy are very likely to buy a personal umbrella
policy. Algorithms are then used to identify potential customers who might be
and intentional losses?
Give this one a try later!
Hard fraud
Statute of limitations
Give this one a try later!
A law that stipulates the length of time after an even during which legal
proceedings (such as a lawsuit or criminal charges may be initiated
,Claims rep Lily is negotiating a claim settlement with an unrepresented claimant and
wishes to smooth the process. She is matching her demeanor, tone, and mannerisms
to those of the claimant. Lily is using which one of the following negotiation
techniques?
Give this one a try later!
Using traditional sales techniques
The first step in the data mining process is to
Give this one a try later!
Understand what a business wants to achieve
Claims representative
Give this one a try later!
A person responsible for investigating, evaluating, and settling claims
Soft fraud, or opportunity fraud
Give this one a try later!
, Fraud that occurs when a legitimate claim is exaggerated
Part of the continuous cycle of data mining is preparing the data to eliminate missing
or inaccurate information. This process is called
Give this one a try later!
Cleaning
Before making initial contact with an insured or claimant, a claims representative
should
Give this one a try later!
Prepare a list of questions for the insured
Machine learning
Give this one a try later!
Artificial intelligence in which computers continually teach themselves to
make better decisions based on previous results and new data
Which one of the following statements regarding subrogation is most accurate?
Give this one a try later!
, Most policies require the insured to cooperate with the insurer in
recovering payment through subrogation, to include testifying or
appearing in court.
One of Juan's responsibilities as a claims representative is to prepare internal reports,
such as preliminary, interim, large loss, and captioned. Which one of the reports Juan
prepares is required for claims with reserves that exceed a specified threshold?
Give this one a try later!
Large loss
Max is a claims rep conducting a complicated claim investigation. How can he ensure
that he's established the foundation for handling the claim in good faith?
Give this one a try later!
Max will know if he practiced good-faith claim handling if the claim
investigation is: • Timely—Prompt contact reassures insureds and claimants
that their claims are important and makes them less likely to accept the
advice of others, who may encourage them to retain a lawyer or pursue
unnecessary litigation. • Thorough—He should collect all relevant and
necessary evidence for as long as new facts develop or become available.
• Unbiased—Claims reps should make decisions only after gathering
sufficient information, remaining alert for new information that may change
the course of the claim.
Through data mining, Goshen Mutual discovers that customers who insure two or
more vehicles on a personal auto policy are very likely to buy a personal umbrella
policy. Algorithms are then used to identify potential customers who might be
