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Reliance Matrix · 2 hours ago

Claims Examiner II - Absence Management Specialist

South Portland, ME

Full-time

Hybrid

Mid Level

$23.24/hr - $29.04/hr

Reliance Matrix is a company focused on providing inclusive culture and employee wellbeing. They are seeking a Claims Examiner II - Absence Management Specialist responsible for managing claims, resolving issues, and ensuring compliance with regulations.

Employee BenefitsFinancial ServicesInsuranceMental HealthRetirement

Responsibilities

Investigates claim issues providing resolution within departmental and regulatory guidelines

Interprets and administers contract provisions: eligibility and duration

Accurately codes all system fields with correct financial, diagnosis and duration information

Coordinates with other departments to ensure appropriate claims transition or facilitate timely return to work

Adheres to compliance, departmental procedures, and Unfair Claims Practice regulations

Makes determinations to approve, deny or delay and or reach out to additional resources for review, based on medical certification review and management

Determines the duration associated with the leave and or disability based on the information given by the healthcare provider

Process medium to high complexity or technically difficult claims

Develops and manages claims thought well developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution

Actively contributes to customer service, quality and performance objectives

Proactively engages in departmental training to remain current with all claim management practices

Responsible for managing Performance Guarantee clients and meet targeted metrics

Responsible and accountable for maintaining and protecting personal health information. Must maintain a high level of confidentiality and abide by HIPPA rules and regulations

Qualification

Claims managementAnalytical skillsAttention to detailMicrosoft OfficeCustomer serviceWritten communicationVerbal communicationOrganizational skillsCollaboration skills

Required

High School Diploma or GED

Ability to develop proficiency regarding required RSL products, systems and processes related to the effective delivery of new business proposals

Microsoft Office experience

Attention to detail, analytical skills, and the ability to collaborate with others and work independently

Strong organizational skills, including the ability to prioritize work and multi-task

Customer service experience and orientation

Written and verbal communication skills

Preferred

Bachelor's 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