LTD Claims Examiner Sr.

Reliance Matrix•Arizona, AZ

4d•$63,540 - $79,440

About The Position

The Senior LTD Claims Examiner investigates and adjudicates complex long-term disability, voluntary disability, and waiver-of-premium claims. The role makes claim determinations based on all available information and the applicable policy terms, while complying with claim policies, procedures, and state and federal regulations. The examiner manages a caseload independently, provides respectful and accurate customer service, and contributes subject-matter expertise, mentoring, training, and process-improvement support. Work location may be flexible with company approval; hybrid arrangements are available for eligible roles.

Requirements

High school diploma or GED.
Five years of experience processing long-term disability claims.
Advanced understanding of claim management techniques and critical thinking in analytical or investigative work.
Experience working in confidential or protected-identification environments.
Thorough knowledge of medical terminology.
Excellent mathematics and calculation skills.
Demonstrated ability to work well in a high-visibility, public-oriented environment.
Ability to travel: none.
Physical ability to sit for prolonged periods; frequently stand, walk distances up to one mile, bend, crouch, kneel, and reach; occasionally lift 25 pounds; type extensively and handle small objects using primarily the fingers.
Visual acuity sufficient to prepare and analyze data and figures, transcribe notes, view a computer terminal, and read extensively.
Hearing sufficient to understand verbal instructions and answer telephones.

Nice To Haves

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

Responsibilities

Obtain and analyze information to make claim decisions and payments on LTD, voluntary disability, and waiver-of-premium claims.
Review and investigate disability claims through telephone and written contact with claimants, employers or supervisors, credit unions, treating physicians, and other applicable parties.
Adjudicate claims accurately and fairly according to contracts, claim policies and procedures, and state and federal regulations, while meeting productivity and quality standards.
Use appropriate medical and risk resources, follow referral policies, and transfer claims to the appropriate risk level in a timely manner.
Conduct in-depth pre-existing-condition or contestable investigations when applicable.
Calculate benefit payments, including partial disability, integration with other income sources, survivor, and residual disability benefits.
Develop and maintain online claim data and paper files when applicable.
Provide respectful, prompt, concise, and accurate customer service while managing competing demands.
Fully investigate and adjudicate complex claims; simple claims are not part of the review workload.
Identify and investigate changes in the Total Disability definition, including any-occupation determinations.
Independently review and manage highly complex claims within a $3,000-per-month approval authority limit.
Independently determine eligibility for waiver of premium for policyholders with life policies up to $225,000.
Administer claims for sensitive or complicated policyholders as needed.
Independently manage an assigned caseload of 60–80 complex cases.
Collaborate with team members and management to recommend and implement improvement opportunities.
Serve as a team subject-matter expert and provide mentoring or training support to newer examiners and support claims-related projects.
Assist management with pre-sale presentations and the investigation and resolution of problems or complaints.
Assist management in responding to Insurance Department inquiries and executive complaints.
Identify team trends and training needs.
Perform other duties as assigned.

Benefits

Annual performance bonus for all team members.
401(k) company match that is immediately vested.
Choice of three medical plans, including prescription drug coverage; company contribution to a Health Savings Account for High Deductible Health Plan enrollees.
Dental and vision coverage options.
Company-provided life and disability insurance.
Paid parental leave and adoption assistance.
Hybrid work arrangements for eligible roles.
Tuition reimbursement and continuing professional education.
At least 20 days of paid time off per year for new hires, with potential increases based on company level and years of service.
Nine company-paid holidays.
Volunteer days and community partnerships.
Employee Assistance Program.
Employee Resource Group program.