LTD Claims Examiner I

Job Responsibilities and Requirements

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

The goal of the position / role is to consistently render appropriate claim determinations based on a review of all available information and the terms and provisions of the applicable policy.

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.

Analysis and Adjudication

Fully investigates simple claims, and submits recommendation to higher level examiners or leadership for review and payment approval.

Case Management

• Manages assigned case load of 60-80 simple cases.
• Partners with supervisor or Sr. Examiners to develop desk management capabilities and priorities to ensure all claims commitments are met in the timeframe expected.

Work location may be flexible if approved by the Company.

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.

Our 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, 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
• Integrity
• Empowerment
• Compassion
• Collaboration

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.

LI-Hybrid .