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.