STD Examiner

Job Responsibilities and Requirements

Obtains and analyzes data for thorough, fair, objective, and timely adjudication of Short Term Disability claims. The goal of the position / role is to consistently pay the accurate amount for each claim in accordance with the contract.

Research

• Develop an understanding and working knowledge of disability products, policies and contracts.
• Develop an understanding of the applicable contract / policy definitions of disability and relevant provisions, clauses, exclusions, riders and waivers as well as statutory requirements.
• Become familiar with reference materials and tools regarding medical, vocational and disability issues.
• Develop an operating knowledge of the applicable disability claims system(s).
• Develop basic medical and technical 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.
• Provides payment or denials promptly and in full compliance with department procedures and regulations.
• Involves technical resources (Social Security specialist, medical resources, and vocational resources) at appropriate claim junctures.
• Researches contract specifics regarding eligibility and pre-existing formulas in reference to specific claim.
• Pro-actively communicates with claimants, policyholders, and physicians to resolve investigations issues.

Case Management

• Utilizes appropriate intervention for the characteristics of each claim.
• Manages assigned case load of 110-120 simple and some complex cases with oversight from independently.
• 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.

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
• Integrity
• Empowerment
• Compassion
• Collaboration

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.

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