Adjudications Officer

About the Company

Truist Financial Corporation is a purpose-driven financial services company committed to inspiring and building better lives and communities. With a long-standing history of client satisfaction and community support, Truist offers a wide range of services including banking, lending, insurance, trust, and wealth management solutions. We are dedicated to fostering an inclusive culture where every teammate feels valued and empowered to contribute to our collective success.

Job Description

We are seeking a highly detail-oriented and analytical Adjudications Officer to join our team in Raleigh, NC. The successful candidate will be responsible for reviewing, investigating, and making determinations on complex claims, appeals, or applications in accordance with established policies, procedures, and regulatory guidelines. This role requires a strong commitment to accuracy, impartiality, and customer service, ensuring fair and consistent outcomes. You will work closely with various internal departments and external stakeholders, providing clear and concise communication regarding decisions and processes. This is an excellent opportunity for a professional who thrives in a structured environment and possesses a keen eye for detail.

Key Responsibilities

• Conduct thorough and impartial review of claims, appeals, and applications, ensuring compliance with all relevant regulations, policies, and procedures.
• Gather and analyze necessary documentation, evidence, and information to support adjudication decisions.
• Communicate adjudication decisions clearly and concisely, both verbally and in writing, to applicants, claimants, and other stakeholders.
• Maintain accurate and detailed records of all case activities, correspondence, and decisions in the designated systems.
• Identify and escalate complex or high-risk cases to senior management or legal counsel as appropriate.
• Collaborate with internal departments (e.g., Legal, Compliance, Operations) to resolve issues and ensure consistent application of policies.
• Stay updated on changes in regulations, policies, and industry best practices relevant to adjudication processes.
• Participate in training and quality assurance activities to continuously improve process efficiency and decision accuracy.

Required Skills

• Proven experience in claims adjudication, regulatory compliance, legal support, or a similar analytical role.
• Exceptional analytical and problem-solving abilities with a strong attention to detail.
• Excellent written and verbal communication skills, capable of explaining complex decisions clearly.
• Ability to interpret and apply complex policies, procedures, and regulatory requirements.
• Proficiency in using case management systems and standard office software (e.g., Microsoft Office Suite).
• Strong organizational skills and ability to manage a high volume of cases effectively.
• Ability to maintain objectivity and impartiality in decision-making.

Preferred Qualifications

• Bachelor's degree in Business Administration, Legal Studies, Finance, Public Policy, or a related field.
• Experience in the financial services industry, particularly with dispute resolution or regulatory affairs.
• Knowledge of relevant financial regulations (e.g., consumer protection laws, banking regulations).
• Certifications in compliance, legal support, or risk management.

Perks & Benefits

• Comprehensive medical, dental, and vision insurance plans.
• 401(k) retirement plan with company match.
• Paid time off, including vacation, sick leave, and holidays.
• Tuition reimbursement and professional development opportunities.
• Employee assistance program and wellness initiatives.
• Life and disability insurance.
• Employee banking benefits.

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