LTD Claims Examiner II

Reliance Matrix; Phoenix (AZ); Hybrid; USD 52,450 - 65,570; Full time

Benefits offered by this job

Annual performance bonus

401(k) company match

Choice of medical plans

Paid Time Off

Tuition Reimbursement

Hybrid work arrangements

Job summary

A leading insurance firm in Phoenix is seeking a Claims Analyst to manage and adjudicate disability claims. The ideal candidate will have at least 2 years of experience in long-term disability claims processing with strong analytical skills and a background in medical terminology. This role offers a competitive salary ranging from $52,450 to $65,570 annually and a comprehensive benefits package, including hybrid work options and paid time off.

Qualifications

• 2 years experience processing long term disability claims.
• Demonstrated understanding of claim management techniques and critical thinking.
• Proven ability to work in a high-visibility, public-oriented environment.

Responsibilities

• Review and investigate disability claims using various contact methods.
• Adjudicate claims accurately following policies and regulations.
• Provide customer service in a respectful and accurate manner.

Skills

Claim management techniques

Critical thinking

Medical terminology

Math and calculation skills

Working in confidential environments

Education

High School Diploma or GED

Associates degree in Business, Finance, Social Work, or Human Resources

Level I LOMA designation

Job description

Job Responsibilities and Requirements

Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and Waiver of Premium claims. The goal of the position/role is to consistently render appropriate claim determinations based on a review of all available information and the terms and provisions of the applicable policy.

• Reviews and investigates disability claims by using telephone and written contact with the applicable parties (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim.
• Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line.
• Utilizes appropriate medical and risk resources, adhering to referral policies, and transferring claims to the appropriate risk level in a timely manner.
• Conducts in-depth pre-existing condition or contestable investigations if applicable.
• Calculates benefit payments, which may include partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, etc.
• Develops and maintains online claim data (and paper file if applicable).
• Provides customer service that is respectful, prompt, concise, and accurate in an environment with competing demands.

Analysis and Adjudication

• Fully investigates and adjudicates a large volume of simple to complex claims.
• Identifies and investigates changes in Total Disability definition (any occ).
• Independently reviews and manages claims with a high degree of complexity within the $1,500 per month approval authority limit.
• Independently determines if a policyholder with a life policy up to $125,000 is eligible for a waiver of premium.
• Majority of work is not subject to supervisor review and approval.

Case Management

• Consistently manages assigned case load of 60-80 simple to complex cases independently.
• Collaborates with team members and management in identifying and implementing improvement opportunities.

Qualifications

• High School Diploma or GED. Associates degree in Business, Finance, Social Work, or Human Resources preferred. Level I LOMA designation preferred.
• 2 years experience processing long term disability claims.
• Demonstrated understanding of claim management techniques and critical thinking in activities requiring analysis and/or investigation.
• Experience working in confidential/protected identification environments.
• Knowledge of medical terminology.
• Good math and calculation skills.
• Proven ability to work well in a high-visibility, public-oriented environment.

Ability to Travel

None

Pay Range and Location

The expected hiring range for this position is $52,450.00 - $65,570.00 annually for work performed in the primary location (Phoenix, AZ). This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate’s starting base pay will be based on several factors including work location, job-related skills, experience, qualifications, and market conditions. These ranges may be modified in the future. Work location may be flexible if approved by the Company.

What We Offer

At Reliance Matrix, we believe that fostering an inclusive culture allows us to realize more of our potential. And we can’t do this without our most important asset—you.

That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing.

Our Benefits

• An annual performance bonus for all team members
• Generous 401(k) company match that is immediately vested
• A choice of three medical plans (that include prescription drug coverage) to suit your unique needs. For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account
• Multiple options for dental and vision coverage
• Company provided Life & Disability Insurance to ensure financial protection when you need it most
• Family friendly benefits including Paid Parental Leave & Adoption Assistance
• Hybrid work arrangements for eligible roles
• Tuition Reimbursement and Continuing Professional Education
• Paid Time Off – new hires start with at least 20 days of PTO per year in addition to nine company paid holidays. As you grow with us, your PTO may increase based on your level within the company and years of service.
• Volunteer days, community partnerships, and Employee Assistance Program
• Ability to connect with colleagues around the country through our Employee Resource Group program

Our Values

• Integrity
• Empowerment
• Compassion
• Collaboration
• Fun

EEO Statement

Reliance Matrix is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications.