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Reliance Matrix · 6 hours ago

Claims Examiner I - SSL

Canandaigua, NY

Full-time

Hybrid

Entry Level

$22.41/hr - $28.02/hr

1+ years exp

Reliance Matrix is a company that focuses on processing claims for New York State statutory Short-Term Disability and Paid Family leave. The Claims Examiner I role involves obtaining and analyzing data to ensure accurate and timely processing of claims, as well as managing a caseload and providing excellent customer service.

Employee BenefitsFinancial ServicesInsuranceMental HealthRetirement

Responsibilities

Develop an understanding and working knowledge of disability and paid family leave

Develop an understanding of the applicable claim definitions and relevant provisions, clauses, exclusions, riders and waivers for the necessary requirements

Develop an operating knowledge of the applicable claims system(s)

Develop basic claims skills and an understanding of claim practices and procedures

Utilizes most efficient means to obtain claim information

Fully investigates all relevant claim issues with oversight by Manager when needed

Provides payment or denials promptly and in full compliance with department procedures and regulations

Researches specifics regarding eligibility and pre-existing formulas in reference to specific claim

Pro-actively communicates with claimants, policyholders, and physicians when applicable

Utilizes appropriate intervention for the characteristics of each claim

Manages assigned case load and processes within the specified time requirements

Good written documentation that provides clear, concise and accurate information to claimants as well as within the claims administrative system

Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands

Establishes, communicates, and manages claimant and policyholder expectations

Documents claim file actions and telephone conversations appropriately

Ability to handle confidential information with the utmost judgment and discretion

Qualification

Disability claims processingPaid Family Leave claimsMicrosoft OfficeInformation analysisDecision-makingCustomer serviceWritten communicationTeamworkTime management

Required

High school diploma (or equivalent)

Must have 1-3 years of New York State statutory Disability and Paid Family leave claims processing experience to be considered for this role

Experience with Microsoft Office

Work experience in decision-making and information analysis

Demonstrated prioritization and organization skills

Ability to communicate clearly and succinctly verbally and in writing

Must be able to work in a team oriented environment

Meet and exceed production, attendance, quality and service

Ability to organize work, manage time and follow through

Availability to work overtime when required

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