Complex Denials Consultant (Complex Claims)
Posted Jun 25, 2026 · We last checked this listing on Oct 6, 2026
Likely interview questions for this role
Written from this job description, not a generic list. Each one notes what the interviewer is really checking.
About your past
Tell me about an appeal you wrote that got a denial overturned. What made it work?
What they are checking: Whether they can build a persuasive written argument from records, statutes and contract language rather than just restating the claim.
Tell me about a time you had to learn a complicated regulation quickly and then explain it to someone else.
What they are checking: Whether they can absorb dense rules and turn them into plain guidance that coworkers can actually act on.
How do you keep your notes and documentation so that someone else could pick up your claim tomorrow?
What they are checking: Whether their records are complete enough to protect recovery if a case goes to hearing or changes hands.
What would you do
A workers comp claim was denied because the carrier says the injury isn't work related. What do you do first?
What they are checking: Whether they gather the facts and the state rules before writing anything, instead of firing off a generic appeal.
You have forty denied claims in your queue and limited time. How do you decide which ones to work first?
What they are checking: Whether they prioritize by dollar value, filing deadlines and odds of recovery instead of working the oldest first by habit.
An internal team keeps sending claims to the wrong payer and they keep getting denied. How would you advise them?
What they are checking: Whether they can fix the root cause with clear guidance to stakeholders instead of just reworking the same denials forever.
An attorney's office for the patient isn't returning your calls about a settlement that should pay the hospital. How do you keep that claim moving?
What they are checking: Whether they stay persistent and professional with outside parties while documenting every attempt for the record.
About the work
Walk me through how billing sequencing works when a patient was hurt in a car accident and also has health insurance and possibly workers comp.
What they are checking: Whether they understand coordination of benefits well enough to bill the right payer first and avoid avoidable denials.
How do state-specific statutes change the way you handle a WC claim from one state to the next?
What they are checking: Whether they know that fee schedules, filing deadlines and lien rules vary by state and how they keep track of those differences.
What do you know about lien filing on a motor vehicle accident or third party liability claim, and when would you recommend filing one?
What they are checking: Whether they understand liens as a recovery tool for hospitals and the timing and notice rules that make them hold up.
How is billing the VA for a veteran's care different from billing a commercial payer?
What they are checking: Whether they know VA claims follow federal rules, authorizations and timelines that differ from typical insurance.
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Practice this out loudThe full job description
As published by R1 RCM.