Claims Examiner II - SSL

Key Responsibilities

• The Claims Examiner I obtains and analyzes data for thorough, fair, objective, and timely processing of New York State statutory Short-Term Disability and Paid Family leave claims.
• The goal of the position/role is to consistently pay the accurate amount for each claim in accordance with the current laws/regulations.
• Research Develops an understanding and working knowledge of disability and paid family leave.
• Develops an understanding of the applicable claim definitions and relevant provisions, clauses, exclusions, riders and waivers for the necessary requirements.
• Develops an operating knowledge of the applicable claims system(s).
• Utilizes most efficient means to obtain claim information.
• Analyzes and adjudicates 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.
• Case Management 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.
• Customer Service Provides 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.
• Able to handle confidential information with the utmost judgment and discretion.

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

• 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
• Able to communicate clearly and succinctly verbally and in writing
• Able to work in a team oriented environment
• Meet and exceed production, attendance, quality and service
• Able to organize work, manage time and follow through
• Able to work overtime when required
• Able to travel: None
• Physical Requirements Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objects, and otherwise using primarily the fingers rather than the entire hand. Employee is required to have visual acuity sufficient to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones.

What We Offer

• An annual performance bonus for all team members
• A 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.
• Volunteer days, community partnerships, and Employee Assistance Program
• Ability to connect with colleagues around the country through our Employee Resource Group program

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.