Claims Examiner analyzing Workers Compensation claims for Sedgwick, a global risk management leader. Join a caring culture with flexible work arrangements and professional growth opportunities.
About the role
- 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
- 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
Job title
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