Claims Examiner

2 weeks ago

Philadelphia, Pennsylvania, United States Reliance Matrix Full time
Job Summary

We are seeking a skilled Claims Examiner to join our team at Reliance Matrix. As a Claims Examiner, you will be responsible for managing an assigned caseload of Long Term Disability cases, including claims with longer duration and evolving medical conditions.

Key Responsibilities
  • Proactively manage your block of claims by regularly talking with and knowing your customers, their level of functioning, and having a command of case facts for each claim in your block.
  • Develop and document Action Plans that focus on the future direction of the claim using a holistic viewpoint.
  • Leverage claim dashboard to manage claim inventory to find which claims to focus efforts on for maximum impact.
  • Have discussions with customers and employers regarding return to work opportunities and communicate with an action-oriented approach.
  • Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis.
  • Ask focused questions of internal resources (e.g. nurse, behavioral, doctor, vocational) and external resources (customer, employer, treating provider) in order to question discrepancies, close gaps and clarify inconsistencies.
  • Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information.
  • Execute on all client performance guarantees.
  • Respond to all communications within customer service protocols in a clear, concise and timely manner.
  • Make fair, accurate, timely, and quality claim decisions.
  • Clearly articulate claim decisions both verbally and in written communications.
Requirements
  • 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.
  • Experience with Stable and Mature Blocks of 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.
What We Offer

At Reliance Matrix, we believe that creating a more diverse, equitable and 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.

  • 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, volunteer days, community partnerships, and Employee Assistance Program.
  • Ability to connect with colleagues around the country through our Employee Resource Group program and our Diversity Equity & Inclusion Council.
Our Values
  • Integrity.
  • Empowerment.
  • Compassion.
  • Collaboration.
  • Fun.
EEO Statement

Reliance 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.

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