LTD Claims Examiner II

Job Responsibilities and Requirements

Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and Waiver of Premium claims. The goal of the position/role is to consistently render appropriate claim determinations based on a review of all available information and the terms and provisions of the applicable policy.

• Reviews and investigates disability claims by using telephone and written contact with the applicable parties (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim.
• Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line.
• Utilizes appropriate medical and risk resources, adhering to referral policies, and transferring claims to the appropriate risk level in a timely manner.
• Conducts in-depth pre-existing condition or contestable investigations if applicable.
• Calculates benefit payments, which may include partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, etc.
• Develops and maintains online claim data (and paper file if applicable).
• Provides customer service that is respectful, prompt, concise, and accurate in an environment with competing demands.

• Fully investigates and adjudicates a large volume of simple to complex claims.
• Identifies and investigates changes in Total Disability definition (any occ).
• Independently reviews and manages claims with a high degree of complexity within the $1,500 per month approval authority limit.
• Independently determines if a policyholder with a life policy up to $125,000 is eligible for a waiver of premium.
• Majority of work is not subject to supervisor review and approval.

• Consistently manages assigned case load of 60-80 simple to complex cases independently.
• Collaborates with team members and management in identifying and implementing improvement opportunities.

• High School Diploma or GED. Associates degree in Business, Finance, Social Work, or Human Resources preferred. Level I LOMA designation preferred.
• 2 years experience processing long term disability claims.
• Demonstrated understanding of claim management techniques and critical thinking in activities requiring analysis and/or investigation.
• Experience working in confidential/protected identification environments.
• Knowledge of medical terminology.
• Good math and calculation skills.
• Proven ability to work well in a high-visibility, public-oriented environment.

None

The expected hiring range for this position is $52,450.00 - $65,570.00 annually for work performed in the primary location (Phoenix, AZ). 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.

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 competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing.

• 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…