Evaluate and analyze documentation for claim payments or denials according to the policy/certificate provisions and state regulations, with increased authority limits.

Responsibilities

  • 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.
  • Manage the review of a claim 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 conducting additional research.
  • Maintain compliance with regulations.
  • May testify in depositions, hearings and trials; communicate the Company’s position regarding the claim.
  • Assist peers with processing questions in the absence of higher level staff.
  • May serve as a back up to review and authorize pending payments calculated by peers, within approval authority.


Qualifications

  • Associate’s degree in a business field or equivalent experience
  • Five years of claims experience
  • In-depth understanding of life and annuity product language, 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

Working Conditions

  • Remote (Call Center) Environment

The Salary for this position generally ranges between $48,000-55,000 annually. Please note that the salary range is a good faith estimate for this position and actual starting pay is determined by several factors including qualifications, experience, geography, work location designation (in-office, hybrid, remote) and operational needs. Salary may vary above and below the stated amounts, as permitted by applicable law.

Additionally, this position is typically eligible for an Annual Bonus based on the Company Bonus Plan/Individual Performance and is at the Company’s discretion.

Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment visa at this time

Disclaimer:
Beware of fake job offers!

We’ve been alerted to scammers impersonating Transamerica recruiters, particularly for remote positions. Please note:

  • We will never request personal information such as ID or payment for equipment upfront.
  • Official offers are sent via DocuSign following a verbal offer—not through text or email.


This job description is not a contract of employment nor for any specific job responsibilities. The Company may change, add to, remove, or revoke the terms of this job description at its discretion. Managers may assign other duties and responsibilities as needed. In the event an employee or applicant requests or requires an accommodation to perform job functions, the applicable HR Business Partner should be contacted to evaluate the accommodation request.