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South Portland, Maine, United States
Hybrid
Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and Waiver of Premium claims. The goal of the position/role is to consistently render appropriate claim determinations based on a review of all available information and the terms and provisions of the applicable policy.
Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim.
Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line.
Utilizes appropriate medical and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner.
Conducts in-depth pre-existing condition or contestable investigations if applicable.
Calculates benefit payments, which may include partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, etc.
Develops and maintains on-line claim data (and paper file if applicable).
Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands.
Analysis and Adjudication
Fully investigates and adjudicates a large volume simple to complex claims.
Identifies and investigates change in Total Disability definition (any occ).
Independently reviews and manage claims with high degree of complexity within the $1,500 per month approval authority limit.
Independently makes the determination if a policyholder with life policy up to $125,000 is eligible for a waiver of premium.
Majority of work is not subject to supervisor review and approval.
Case Management
Consistently manage assigned case load of 60-80 simple to complex cases independently.
Collaborates with team members and management in identifying and implementing improvement opportunities.
REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR RELATED EXPERIENCE
*or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience*
Required Knowledge, Skills, Abilities and/or Related Experience
High School Diploma or GED. Associates degree in Business, Finance, Social Work, or Human Resources preferred. Level I LOMA designation preferred.
2 years experience processing long term disability claims.
Demonstrated understanding of claim management techniques and critical thinking in activities requiring analysis and/or investigation.
Experience working in confidential/protected identification environments.
Knowledge of medical terminology.
Good math and calculation skills.
Proven ability to work well in a high-visibility, public-oriented environment.
Ability to Travel: None
Work location may be flexible if approved by the Company.
What We Offer
At Reliance Matrix, we believe that fostering an 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:
Our Values:
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.
