Remote TPA Claims Examiner

Analyze claims remotely for SIAdvisers “A Custard Company,” applying policy language, liability assessment, and accurate documentation. Communicate clearly with stakeholders throughout claim handling.

This full-time TPA Examiner role reviews, analyzes, and adjudicates claims according to policy terms, regulations, and client guidelines. You will verify coverage, determine payments, and document decisions in claims management systems. The role also supports timely handling, complex-case escalation, process improvement, and quality assurance initiatives.

• Review and adjudicate claims using policy terms and client guidelines
• Verify coverage and assess liability for submitted claims
• Determine appropriate payments and document decisions accurately
• Communicate with policyholders, claimants, agents, and stakeholders
• Escalate complex cases and support quality assurance initiatives

• Experience in claims examination, TPA administration, or insurance adjusting
• Strong understanding of policy language and claim processes
• Proficiency with data entry, documentation, and claims management systems
• AMF license and familiarity with insurance regulations
• Ability to work independently and manage multiple deadlines remotely

Apply claims analysis, regulatory knowledge, and precise communication as a remote TPA Examiner supporting SIAdvisers clients.