Reliance Matrix is a company focused on providing inclusive culture and support to its team members. They are seeking a Claims Examiner I to process New York State statutory Short-Term Disability and Paid Family leave claims, ensuring accurate payments in compliance with laws and regulations.
Responsibilities
- Obtains and analyzes data for thorough, fair, objective, and timely processing of New York State statutory Short-Term Disability and Paid Family leave claims
- 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
Skills
- High school diploma (or equivalent)
- Must have 1-3 years of New York State statutory Disability and Paid Family leave claims processing experience to be considered for this role
- 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
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
Company Overview
Reliance Matrix provides financial protection, absence management, and supplemental health benefits solutions. It was founded in 1907, and is headquartered in Philadelphia, Pennsylvania, USA, with a workforce of 1001-5000 employees. Its website is https://reliancematrix.com.