Senior Claims Examiner

About the role

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.
• 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 backup 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/Hybrid

Pay

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.

What We Offer

• Competitive Pay
• Bonus for Eligible Employees
• Benefits Package
• Pension Plan
• 401(k) 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
• 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.
• Adoption Assistance
• Employee Assistance Program
• Back-Up Care Program
• PTO for Volunteer Hours
• Employee Matching Gifts Program
• Employee Resource Groups
• Inclusion and Diversity Programs
• Employee Recognition Program
• Referral Bonus Programs

What We Offer

For eligible employees, we offer a comprehensive benefits package designed to support both the personal and financial well-being of our employees.

Inclusion & Diversity

• We believe our commitment to diversity and inclusion creates a work environment filled with exceptional individuals.
• We’re thrilled to have been recognized for our efforts through the Human Rights Campaign Corporate Equality Index, Dave Thomas Adoption Friendly Advocate, and several Seramount lists, including the Inclusion Index, 100 Best Companies for Working Parents, Best Companies for Dads, and Top 75 Companies for Executive Women.
• To foster a culture of inclusivity throughout our workforce, workplace, and marketplace, Transamerica offers a wide range of diversity and inclusion programs. This includes our company-sponsored, employee-driven Employee Resource Groups (ERGs), which are formed around a shared interest or a common characteristic of diversity. ERGs are open to all employees. They provide a supportive environment to help us better appreciate our similarities and differences and understand how they benefit us all.

Give Back

• We believe our responsibilities extend beyond our corporate walls. That's why we created the Aegon Transamerica Foundation in 1994. Through a mix of financial grants and the volunteer efforts of our employees, the foundation supports nonprofit organizations focused on the things that matter most to our people in the communities where we live and work.

Transamerica’s Parent Company

Aegon acquired the Transamerica business in 1999. Since its start in 1844, Aegon has grown into an international company serving more than 23.9 million people across the globe.* It offers investment, protection, and retirement solutions, always with a clear purpose: Helping people live their best lives. As a leading global investor and employer, the company seeks to have a positive impact by addressing critical environmental and societal issues, with a focus on climate change and inclusion and diversity. As of December 31, 2023