Lead Claims Examiner

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 referrals/claims which require intense investigation. Process according to policy/certificate provisions and state regulations, with increased authority limits. Review and investigate fraud referrals/claims. Provide claim review and approval up to $1M.

Job Description

Responsibilities

• Analyze information/documentation received to determine how to proceed with the review and/or investigation of a claim and determine methods of obtaining additional information from alternative sources.
• Evaluate and analyze referrals/claims suspected of fraud.  Work with law enforcement agencies, when appropriate, to obtain information or referral for consideration for prosecution.
• Manage the review and/or investigation of a claim and outside sources used in the investigation.
• Document correspondence and conversations.
• Correspond verbally and in writing with claimants, investigators, medical providers, medical examiners, law enforcement, and insurance fraud departments.
• 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.
• Train team members on systems and processes.
• Assist in updating claim processing procedures.
• Assist with department and company-wide projects.
• Testify in depositions, hearings and trials; communicate the Company’s position regarding the claim.
• Execute quality review to check for accuracy and adherence to procedures, sensitive transactions, and regulatory standards including SEC/SOX.
• Respond to insurance department complaints.
• Maintain compliance with regulations.
• Review and authorize pending payments calculated by peers.
• 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
• Eight years of claims experience
• Expert understanding of life or 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

• Office or hybrid office/remote environment

 

*Please note that the compensation information that follows is a good faith estimate for this position only and is provided pursuant to applicable pay transparency and compensation posting laws. It is estimated based on what a successful candidate might be paid in certain Company locations.**

 

The salary for this position generally ranges between $63,000 -70,000 annually. This range is an estimate, based on potential qualifications 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.

 

Worried about not having every single qualification listed? It’s okay. If it’s a role you’re interested in, we encourage you to apply. Employees who enjoy their jobs are one of our favorite things. 

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. 

 

Compensation 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

• College Coach 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

 

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. 

   

Giving 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

 

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