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SalaryJob Responsibilities and Requirements
The Claims Examiner will act as a liaison between client, employee and healthcare provider. In this position, you are responsible for applying appropriate claims management by providing reliable and responsive service to claimants and clients.
Duties and Responsibilities:
- Investigates claim issues providing resolution within departmental and regulatory guidelines.
- Interprets and administers contract provisions: eligibility and duration.
- Accurately codes all system fields with correct financial, diagnosis and duration information.
- Coordinates with other departments to ensure appropriate claims transition or facilitates timely return to work.
- Document claim updates in the claim database ensuring accuracy.
- Maintaining departmental and policyholder expectations.
- Adheres to compliance, departmental procedures, and Unfair Claims Practice regulations.
- Actively contributes to, and maintains, customer service, quality and performance objectives.
- Proactively engages in departmental trainings to remain current with all claim management practices.
- Responsible for managing Performance Guarantees for assigned clients, and meet targeted metrics.
- Responsible and accountable for maintaining and protecting personal, confidential claimant health information. Must maintain a high level of confidentiality and abide by HIPPA rules and regulations.
- Other responsibilities may be assigned as needed.
Essential Job Requirements:
- Strong communication skills both written and verbal. Willingness to communicate regularly with claimants, clients, and intercompany colleagues across the organization as needed.
- Desire to work in a fast-paced, energetic environment, in a customer-facing role.
- Ability to act with empathy and care in all interactions on a daily basis. · Demonstrated proficiency in using a personal computer for routine tasks such as email (Outlook), reports (Excel), and general aptitude to learn proprietary disability software platforms.
- Ability to synthesize and analyze data and information.
- Ability to complete assigned tasks and projects in a timely manner, adhering to deadlines.
- Must maintain prompt a nd consistent, predictable attendance, with ability to work assigned daytime shifts 5 days per week. Ability to work overtime as business demands.
- Ability to interact with employees of all levels and clients in an appropriate manner.
- Ability to concentrate and remain focused on tasks throughout the day and think strategically.
Essential Physical/Cognitive Job Functions:
- Prompt and regular attendance at assigned job locations
- Ability to work shifts exceeding 8 hours, 5 days per week
- Ability to interact with employees of all levels and clients in an appropriate manner
- Ability to concentrate and think strategically
- Availability onsite to confer with staff members with whom the incumbent must interact on a daily basis
- Ability to proficiently use a personal computer for tasks such as email and preparing reports using software
- Ability to review and analyze data and information
- Ability to complete, or oversee the completion of, assigned tasks/projects in a timely manner
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
- Empowerment
- Compassion
- Collaboration
- Fun
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.
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