Senior Claims Examiner ( Work From Home)

Job Family

Claims

About Us 

 

At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests.  

 

Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment — one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. 

     

Who We Are 

  

We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life.  

Today, we’re part of an international holding company, with millions of customers and thousands of employees worldwide. Our insurance, retirement, and investment solutions help people make the most of what’s important to them. 

We’re empowered by a vast agent network covering North America, with diversity to match. Together with our nonprofit research institute and foundation, we tune in, step up, and are a force for good — for our customers and the communities where we live, work, and play. United in our purpose, we help people create the financial freedom to live life on their terms. 

What We Do 

 

Transamerica is organized into three distinct businesses. These include 1) World Financial Group, including Transamerica Financial Advisors, 2) Protection Solutions and Savings & Investments, comprised of life insurance, annuities, employee benefits, retirement plans, and Transamerica Investment Solutions, and 3) Financial Assets, which includes legacy blocks of long term care, universal life, and variable and fixed annuities. These are supported by Transamerica Corporate, which includes Finance, People and Places, General Counsel, Risk, Internal Audit, Strategy and Development, and Corporate Affairs, which covers Communications, Brand, and Government and Policy Affairs. 

 

Transamerica employs nearly 7,000 people. It’s part of Aegon, an integrated, diversified, international financial services group serving approximately 23.9 million customers worldwide.* For more information, visit transamerica.com.  

Job Description Summary

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

Job Description

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