LTD Claims Examiner II

Reliance Matrix•Phoenix, AZ

6d•Remote

About The Position

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 and adjudicates a large volume simple to complex claims. Identifies and investigates change in Total Disability definition (any occ). Independently reviews and manage claims with high degree of complexity within the $1,500 per month approval authority limit. Independently makes the determination if a policyholder with life policy up to $125,000 is eligible for a waiver of premium. Majority of work is not subject to supervisor review and approval. Case Management Consistently manage assigned case load of 60-80 simple to complex cases independently. Collaborates with team members and management in identifying and implementing improvement opportunities.

Requirements

High School Diploma or GED.
2 years experience processing long term disability claims.
Demonstrated understanding of claim management techniques and critical thinking in activities requiring analysis and/or investigation.
Experience working in confidential/protected identification environments.
Knowledge of medical terminology.
Good math and calculation skills.
Proven ability to work well in a high-visibility, public-oriented environment.
Ability to Travel: None

Nice To Haves

Associates degree in Business, Finance, Social Work, or Human Resources preferred.
Level I LOMA designation preferred.

Responsibilities

Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and Waiver of Premium claims.
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.
Fully investigates and adjudicates a large volume simple to complex claims.
Identifies and investigates change in Total Disability definition (any occ).
Independently reviews and manage claims with high degree of complexity within the $1,500 per month approval authority limit.
Independently makes the determination if a policyholder with life policy up to $125,000 is eligible for a waiver of premium.
Consistently manage assigned case load of 60-80 simple to complex cases independently.
Collaborates with team members and management in identifying and implementing improvement opportunities.

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