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.
Analysis and Adjudication
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
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
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
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 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
Ability to Travel: None
PHYSICAL REQUIREMENTS
When used in the description below, the following terms are defined as:
"Occasional": done only from time to time, but necessary when it is performed
"Frequent": regularly performed; generally an act that is required on a daily basis
"Continuous": typically performed for the majority of an employee's shift
CORE VALUES
Collaboration
Compassion
Empowerment
Integrity
Fun
The above description reflects the general details considered necessary to describe the principle responsibilities and functions of the job identified and shall not be construed as a detailed description of all the work requirements that may be inherent to this job.
Work location may be flexible if approved by the Company.
Benefits
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 competitiveVision insuranceFlexible schedule
Rsli · Canandaigua, NY