TPA Examiner

Job summary

Review, analyze, and adjudicate claims by verifying coverage, assessing liability, determining payments, and documenting decisions in accordance with policy terms, regulations, and client guidelines. Communicate with claim stakeholders, coordinate timely handling with internal teams, escalate complex cases, and contribute to process improvement and quality assurance.

Job details

Company Description SIAdvisers “A Custard Company” delivers customized solutions to clients while maintaining industry-leading standards in every aspect of operations. The organization specializes in field claims adjusting, subrogation recovery, and third-party administration (TPA) services, emphasizing accuracy, responsiveness, and client satisfaction. SIAdvisers supports clients with comprehensive claims and TPA capabilities designed to streamline processes and improve outcomes. The team is available 24/7/365, ensuring continuous service and support. This commitment to reliability and expertise creates a dynamic environment for professionals seeking growth in claims and TPA administration. Role Description This is a full-time remote role for a TPA Examiner at SIAdvisers “A Custard Company.” The TPA Examiner will review, analyze, and adjudicate claims in accordance with policy terms, regulatory requirements, and client guidelines. Responsibilities include verifying coverage, assessing liability, determining appropriate payments, and documenting claim decisions clearly and accurately in the system. The role involves regular communication with policyholders, claimants, agents, and other stakeholders to gather information, provide updates, and resolve inquiries. The TPA Examiner will collaborate with internal teams to ensure timely claim handling, escalate complex cases when needed, and contribute to process improvement and quality assurance initiatives. Qualifications Experience in claims examination, TPA administration, or insurance adjusting, with a strong understanding of policy language and claim processes. Proficiency in data entry, documentation, and claims management systems, with attention to accuracy and compliance. Strong analytical and problem-solving skills to evaluate claim information, assess liability, and make sound decisions. Clear written and verbal communication skills for interacting with clients, claimants, and internal stakeholders. Ability to work independently in a remote setting, manage time effectively, and handle multiple claims and deadlines. Familiarity with relevant insurance regulations and industry standards; prior experience in field claims adjusting or subrogation is a plus. AMF licensed Commitment to ethical conduct, confidentiality, and delivering high-quality service to clients and claimants.

What you’ll do

Review, analyze, and adjudicate claims by verifying coverage, assessing liability, determining payments, and documenting decisions in accordance with policy terms, regulations, and client guidelines. Communicate with claim stakeholders, coordinate timely handling with internal teams, escalate complex cases, and contribute to process improvement and quality assurance.

Requirements

Experience in claims examination, TPA administration, or insurance adjusting is required, along with knowledge of policy language, claims processes, and relevant insurance regulations. Candidates should have an AMF license, strong analytical and communication skills, accurate documentation practices, and the ability to work independently and manage multiple claims remotely.

Listed skills

• Time management · Preferred
• Problem solving · Preferred
• Regulatory Compliance · Preferred
• Data entry · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• Claims Examination
• TPA Administration
• Insurance Adjusting
• Policy Interpretation
• Coverage Verification
• Liability Assessment
• Claims Adjudication
• Claims Documentation
• Claims Management Systems
• Data Entry
• Analytical Skills
• Problem-Solving
• Stakeholder Communication
• Time Management
• Regulatory Compliance
• AMF License

Job areas

• Finance & Accounting
• Customer Service & Support