Claims Examiner II - SSL

Reliance Matrix•Canandaigua, NY

1d•$25 - $31•Hybrid

About The Position

The Claims Examiner I obtains and analyzes data for thorough, fair, objective, and timely processing of New York State statutory Short-Term Disability and Paid Family leave claims. The goal of the position/role is to consistently pay the accurate amount for each claim in accordance with the current laws/regulations.

Requirements

High school diploma (or equivalent) or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience
1-3 years of New York State statutory Disability and Paid Family leave claims processing experience
Experience with Microsoft Office
Work experience in decision-making and information analysis.
Demonstrated prioritization and organization skills.
Ability to communicate clearly and succinctly verbally and in writing
Must be able to work in a team oriented environment.
Meet and exceed production, attendance, quality and service
Ability to organize work, manage time and follow through
Availability to work overtime when required

Responsibilities

Develop an understanding and working knowledge of disability and paid family leave
Develop an understanding of the applicable claim definitions and relevant provisions, clauses, exclusions, riders and waivers for the necessary requirements.
Develop an operating knowledge of the applicable claims system(s).
Develop basic claims skills and an understanding of claim practices and procedures.
Utilizes most efficient means to obtain claim information.
Fully investigates all relevant claim issues with oversight by Manager when needed.
Provides payment or denials promptly and in full compliance with department procedures and regulations.
Researches specifics regarding eligibility and pre-existing formulas in reference to specific claim.
Pro-actively communicates with claimants, policyholders, and physicians when applicable
Utilizes appropriate intervention for the characteristics of each claim.
Manages assigned case load and processes within the specified time requirements.
Good written documentation that provides clear, concise and accurate information to claimants as well as within the claims administrative system.
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.
Ability to handle confidential information with the utmost judgment and discretion

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.
Volunteer days, community partnerships, and Employee Assistance Program
Ability to connect with colleagues around the country through our Employee Resource Group program