Claims Examiner I - SSL

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