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Reliance Matrix · 1 day ago

STD Claims Examiner II

South Portland, ME

Full-time

Hybrid

Entry, Mid Level

$23.24/hr - $29.04/hr

2+ years exp

Reliance Matrix is a company that values inclusivity and offers a range of benefits to its team members. They are seeking a STD Claims Examiner II who will be responsible for obtaining and analyzing information to make claim decisions and payments for Short Term Disability claims, ensuring compliance with policies and procedures.

Employee BenefitsFinancial ServicesInsuranceMental HealthRetirement

Responsibilities

Obtains and analyzes information to make claim decisions and payments of Short Term Disability (STD) claims

Applies knowledge of disability products, policies and contracts

Interprets and applies contract/policy definitions of disability and relevant provisions, clauses, exclusions, riders and waivers as well as statutory requirements

Utilizes reference materials and tools regarding medical, vocational and disability issues to identify and evaluate claim information in a fair and objective manner

Efficient use of applicable disability claims system(s)

Applies routine medical and technical claims skills, practices, and procedures

Utilizes most efficient means to obtain claim information

Fully investigates all relevant claim issues

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

Involves technical resources (Social Security specialist, medical resources, and vocational resources) at appropriate claim junctures

Determine and implement appropriate return to work strategy for assigned cases

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

Communicates with claimants, policyholders, and physicians to resolve investigations concerns

Comfortably makes balanced decisions in situations where there are potential adverse consequences

Utilizes appropriate intervention for the characteristics of each claim

Manages assigned case load of 100-110 complex and some simple cases independently

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

Manages appropriate volumes, consistently meeting turnaround times, high activity levels, and quality focus on timely claim activities

Consistently remain within workflow guidelines on diaries and casework & adjust desk management if needed

Provides clear, concise and accurate information to claimants as well as the claims administrative system

Serves as a subject matter expert within team, provides some mentor support for newer examiners to assist in their development

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

Qualification

STD claims examinationDisability products knowledgeCase managementLOMA DesignationCustomer serviceProblem analysisInterpersonal skillsTime management

Required

2 years STD claims examiner experience (Short Term Disability)

Associates Degree, Bachelors Preferred

Promptly acknowledges customers' needs, both internal and external. Ensures customers' needs are handled in a timely and appropriate manner. Creates a positive impression

Demonstrates effective interpersonal and listening skills: takes direction, practices active listening, accepts feedback. Communicate/respond appropriately to varied audiences/tasks. Exhibits teamwork, honors commitments

Anticipates, analyzes and defines problems. Develops and assesses alternative solutions as necessary. Makes appropriate decisions in a timely manner. Analyzes impact of decisions

Work is accomplished quickly and accurately. Takes responsibility for actions. Prioritizes work effectively and uses time efficiently. Accomplishes goals and objectives

Makes/fulfills commitments. Consistently works independently, meets deadlines, and accepts responsibility for his/her actions. Adheres to all attendance requirements. Prompt, well prepared and ready to contribute

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