LTD Claims Examiner Sr.

Reliance Matrix; EE. UU.; Híbrido; USD 64.000 - 79.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Annual performance bonus

401(k) company match

Medical plans (3 options)

Health Savings Account company contrib

Dental and Vision coverage

Life & Disability Insurance

Paid Parental Leave & Adoption Assist.

Hybrid work arrangements

Tuition Reimbursement & Continuing Pro

Paid Time Off + holidays

Volunteer days & EAP

Descripción de la vacante

Reliance Matrix is hiring for a claims examiner role focused on long-term disability and related benefits. You will obtain and analyze information, adjudicate complex claims, and ensure accurate payments under policy terms and regulations.

The position emphasizes independent handling of high-complexity cases, collaboration within the team, and ongoing process improvements. The role requires strong math, analytical thinking, and experience with confidential information.

Formación

• High School Diploma or GED.
• Associates degree in Business, Finance, Social Work, or Human Resources preferred. Level I LOMA designation preferred.
• 5 years experience processing long term disability claims.
• Advanced understanding of claim management techniques and critical thinking in activities requiring analysis and/or investigation.
• Experience working in confidential/protected identification environments.
• Thorough knowledge of medical terminology.
• Excellent math and calculation skills.
• Proven ability to work well in a high-visibility, public-oriented environment.
• Ability to Travel: None

Responsabilidades

• Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and WOP claims.
• Reviews and investigates disability claims by using telephone and written contact with the applicable parties to gather pertinent data.
• Adjudicates claims accurately and fairly in accordance with the contract, policies and procedures, and regulations.
• Uses medical and risk resources and transfers claims to the appropriate risk level in a timely manner.
• Conducts in-depth investigations of pre-existing conditions or contestable claims when applicable.
• Calculates benefit payments including partial disability and survivor benefits.
• Develops and maintains online claim data (and paper files if applicable).
• Provides respectful, prompt, and accurate customer service in a high-demand environment.
• Independent management of complex claims up to $3,000 per month and waiver of premium eligibility decisions.
• Case management of 60-80 complex cases, with collaboration and process improvements.

Conocimientos

Math skills

Critical thinking

Attention to detail

Confidential environments

Claim management knowledge

Educación

High School Diploma or GED

Associates degree in Business/Finance/Social Work/HR

Level I LOMA designation

Descripción del empleo

Job Responsibilities and RequirementsKey Responsibilities**Other duties as assignedObtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and WOP 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 polices, 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 on-line claim data (and paper file if applicable).Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands.Analysis and AdjudicationFully investigates and adjudicates a large volume complex claims, does not review simple claims.Identifies and investigates change in Total Disability definition (any occ).Independently reviews and manage claims with high degree of complexity within the $3,000 per month approval authority limit.Independently makes the determination if a policyholder with life policy up to $225,000 is eligible for a waiver of premium.May handle the claim administration for sensitive or complicated policyholders.Majority of work is not subject to supervisor review and approval.Case ManagementConsistently manage assigned case load of 60-80 complex cases independently.Collaborates with team members and management in recommending and implementing improvement opportunities.MiscellaneousSeen as subject matter expert within team and provides mentor or training support for newer Examiners to assist in their development or on claims related projects.Assists management in pre-sale presentations, problem/complaint investigation and resolution.Assists management in responding to Insurance Department inquiries and executive complaints.Identify trends or training needs of the team.REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR RELATED EXPERIENCE*or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience*Required Knowledge, Skills, Abilities and/or Related ExperienceHigh School Diploma or GED. Associates degree in Business, Finance, Social Work, or Human Resources preferred. Level I LOMA designation preferred.5 years experience processing long term disability claims.Advanced understanding of claim management techniques and critical thinking in activities requiring analysis and/or investigation.Experience working in confidential/protected identification environments.Thorough knowledge of medical terminology.Excellent math and calculation skills.Proven ability to work well in a high-visibility, public-oriented environment.Ability to Travel: NonePHYSICAL REQUIREMENTSWhen used in the description below, the following terms are defined as:“Occasional”: done only from time to time, but necessary when it is performed“Frequent”: regularly performed; generally an act that is required on a daily basis“Continuous”: typically performed for the majority of an employee’s shiftSitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objecting and otherwise using primarily the fingers rather than the entire hand. Employee is required to have visual acuity sufficient to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones. Reliance Matrix will provide qualified employees with a reasonable accommodation in accordance with applicable law.CORE VALUESCollaborationCompassionEmpowermentIntegrityFunThe above description reflects the general details considered necessary to describe the principle responsibilities and functions of the job identified and shall not be construed as a detailed description of all the work requirements that may be inherent to this job.The expected hiring range for this position is $63,540.00 - $79,440.00 annually. 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 OfferAt 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 membersGenerous 401(k) company match that is immediately vestedA 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 AccountMultiple options for dental and vision coverageCompany provided Life & Disability Insurance to ensure financial protection when you need it mostFamily friendly benefits including Paid Parental Leave & Adoption AssistanceHybrid work arrangements for eligible rolesTuition Reimbursement and Continuing Professional EducationPaid 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 ProgramAbility to connect with colleagues around the country through our Employee Resource Group programOur Values:Sustainable PerformanceContinuous ImprovementCustomer ExperienceCollaborationEmpowermentSense of CommunityEEO StatementReliance 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.#LI-Remote #LI-MR1