Senior LTD Claims Examiner (Remote) - Complex Adjudication

Reliance Matrix; United States; Hybrid; USD 64,000 - 79,000; Full time

Benefits offered by this job

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

Job summary

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.

Qualifications

• 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

Responsibilities

• 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.

Skills

Math skills

Critical thinking

Attention to detail

Confidential environments

Claim management knowledge

Education

High School Diploma or GED

Associates degree in Business/Finance/Social Work/HR

Level I LOMA designation

Job description

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.