Claims Examiner role at Transamerica evaluating documentation for claims processing. Collaborating with various teams while maintaining compliance with regulations and monitoring for fraud.
Responsibilities
Evaluate and analyze documentation for claim payments or denials according to the policy/certificate provisions and state regulations, with moderate authority limits
Under general supervision, analyze information/documentation received to determine how to proceed with a review of a claim and determine methods of obtaining additional information from alternative sources
Review claims and outside sources used in the review
Document correspondence and conversations
Correspond verbally and in writing with claimants, medical providers, medical examiners, and law enforcement
Work closely with department manager, legal counsel, medical director, claims assistants, and other departments to gather information for contested claims
Monitor claims for fraud and proceed according to each situation, such as engaging the Fraud team or additional research
Maintain compliance with regulations
Requirements
Associate’s degree in a business field or equivalent experience
Two years of claims experience
Good understanding of life and annuity product language and provisions, and regulatory/compliance rules and regulations
Excellent communication and customer service skills
Organizational, problem-solving and analytical skills
Ability to cross train and learn other products
Ability to multi-task and adapt to change
Benefits
Competitive Pay
Bonus for Eligible Employees
Benefits Package
Pension Plan
401k Match
Employee Stock Purchase Plan
Tuition Reimbursement
Disability Insurance
Medical Insurance
Dental Insurance
Vision Insurance
Employee Discounts
Career Training & Development Opportunities
Health and Work/Life Balance Benefits
Paid Time Off starting at 160 hours annually for employees in their first year of service
Ten (10) paid holidays per year (typically mirroring the New York Stock Exchange (NYSE) holidays)
Be Well Company holistic wellness program, which includes Wellness Coaching and Reward Dollars
Parental Leave – fifteen (15) days of paid parental leave per calendar year to eligible employees with at least one year of service at the time of birth, placement of an adopted child, or placement of a foster care child
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