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Reliance Matrix · 2 hours ago

LTD Claims Examiner II

United States

Full-time

Remote

Entry, Mid Level

$51K/yr - $69K/yr

2+ years exp

Reliance Matrix is a company that focuses on insurance services, and they are seeking an LTD Claims Examiner II. The role involves obtaining and analyzing information to make claim decisions, adjudicating claims, and managing a caseload of disability claims while ensuring compliance with relevant policies and regulations.

Employee BenefitsFinancial ServicesInsuranceMental HealthRetirement

Responsibilities

Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and Waiver of Premium claims

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

Fully investigates and adjudicates a large volume simple to complex claims

Identifies and investigates change in Total Disability definition (any occ)

Independently reviews and manage claims with high degree of complexity within the $1,500 per month approval authority limit

Independently makes the determination if a policyholder with life policy up to $125,000 is eligible for a waiver of premium

Majority of work is not subject to supervisor review and approval

Consistently manage assigned case load of 60-80 simple to complex cases independently

Collaborates with team members and management in identifying and implementing improvement opportunities

Qualification

LTD claims processingClaim management techniquesMedical terminologyMath skillsCritical thinkingConfidentiality experienceHigh school diplomaGEDBusiness degreeFinance degreeSocial work degreeHuman resources degreeLOMA designation

Required

High School Diploma or GED

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

Preferred

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

Level I LOMA designation preferred

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