Job Responsibilities and Requirements
The Claims Examiner will act as a liaison between client, employee and healthcare provider. In this position, you are responsible for applying appropriate claims management by providing reliable and responsive service to claimants and clients.
Description of responsibilities:
- Investigates claim issues providing resolution within departmental and regulatory guidelines.
- Interprets and administers contract provisions: eligibility and duration
- Accurately codes all system fields with correct financial, diagnosis and duration information.
- Coordinates with other departments to ensure appropriate claims transition or facilitate timely return to work.
- Adheres to compliance, departmental procedures, and Unfair Claims Practice regulations.
- Actively contributes to customer service, quality and performance objectives.
- Proactively engages in departmental training to remain current with all claim management practices.
- Responsible for managing Performance Guarantee clients and meet targeted metrics.
- Responsible and accountable for maintaining and protecting personal health information. Must maintain a high level of confidentiality and abide by HIPPA rules and regulations.
Qualifications:
- High School Diploma or GED (Bachelor’s preferred)
- Ability to develop proficiency regarding required RSL products, systems and processes related to the effective delivery of new business proposals
- Microsoft Office experience
- Attention to detail, analytical skills, and the ability to collaborate with others and work independently
- Strong organizational skills, including the ability to prioritize work and multi-task
- Customer service experience and orientation
- Written and verbal communication skills.
The expected hiring range for this position is $24.00 hourly for work performed in the primary location (Hawthorne, NY). This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate’s starting base pay will be based on several factors including work location, job-related skills, experience, qualifications, and market conditions. These ranges may be modified in the future.
Work location may be flexible if approved by the Company.
What We Offer
At Reliance Matrix, we believe that creating a more diverse, equitable and 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:
- 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, volunteer days, community partnerships, and Employee Assistance Program
- Ability to connect with colleagues around the country through our Employee Resource Group program and our Diversity Equity & Inclusion Council
Our Values:
- Integrity
- Empowerment
- Compassion
- Collaboration
- Fun
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.
#LI-Hybrid #LI-ZH1
What We Do
Reliance Matrix delivers employee benefits, absence management and workforce productivity solutions through the financial stability of a top-rated insurance carrier, the agility and innovative spirit of a Third Party Administrator (TPA), and the daily commitment of thousands of team members across America. Where larger competitors offer size, we inspire confidence and long term engagement through integration, reliability and dedication to providing customized solutions.
Reliance Matrix innovates and provides technology-driven absence and benefit solutions that enable employees and employers to manage time away from work.
We help employers attract and retain valuable human capital through thoughtful, inclusive benefit programs delivered with care.
We bring top-tier regulatory knowledge and cutting edge technology to help optimize workforce productivity and compliance.
We offer a seamless member experience customized to each individual’s need
and event.
We integrate our solutions and expertise with leading HR technologies to ensure accuracy, efficiency and a superior customer experience.
We are a proud member of the global Tokio Marine Group, one of the oldest, largest and most respected insurance organizations in the world.
In the business hierarchy, human capital is the most precious of assets. Reliance Matrix delivers comprehensive, integrated solutions and services to attract, protect and help optimize an employer’s work force in a changing, challenging world
