Stable & Mature LTD Claims Examiner

$45,115 - $56,410/Yr

Reliance Matrix - South Portland, ME

Full-time - Entry Level

Hybrid - South Portland, ME

About the position

The Stable and Mature LTD Claim Examiner will manage an assigned caseload of Long Term Disability cases, focusing on claims with longer durations and evolving medical conditions. This role involves engaging in meaningful conversations with customers and clinical partners to gather relevant information, performing complex benefit calculations, and ensuring timely and accurate claim decisions.

Responsibilities

• Proactively manage a block of claims by regularly communicating with customers and understanding their level of functioning.
• Develop and document Action Plans focusing on the future direction of each claim using a holistic viewpoint.
• Leverage claim dashboard to manage claim inventory and prioritize efforts for maximum impact.
• Discuss return to work opportunities with customers and employers, communicating in an action-oriented manner.
• Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work on a full-time or modified duty basis.
• Ask focused questions of internal and external resources to clarify discrepancies and close gaps in information.
• Network with customers and physicians to manage claims from initial medical requests to ongoing evaluations.
• Execute on all client performance guarantees and respond to communications within customer service protocols.
• Make fair, accurate, timely, and quality claim decisions, articulating these decisions clearly in both verbal and written communications.

Requirements

• High School Diploma or GED; Associates degree in Business, Finance, Social Work, or Human Resources preferred.
• Level I LOMA designation preferred.
• 5 years' experience processing long term disability claims.
• Experience with Stable and Mature Blocks of Claims.
• Advanced understanding of claim management techniques and critical thinking in analysis and investigation activities.
• Experience working in confidential/protected identification environments.
• Thorough knowledge of medical terminology.
• Excellent math and calculation skills.
• Proven ability to work well in a high-visibility, public-oriented environment.

Benefits

• An annual performance bonus for all team members
• Generous 401(k) company match that is immediately vested
• A choice of three medical plans including prescription drug coverage
• Company contribution to Health Savings Account for High Deductible Health Plan enrollees
• Multiple options for dental and vision coverage
• Company provided Life & Disability Insurance
• 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
• Employee Resource Group program and Diversity Equity & Inclusion Council