LTD Claims Examiner II

Job Responsibilities and Requirements

KEY RESPONSIBILITIES (other duties as assigned)

• Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary Disability and Waiver of Premium claims.
• Reviews and investigates disability claims through telephone and written contact with relevant parties to gather data.
• Adjudicates claims accurately and fairly in accordance with policy, regulations, and procedures, meeting productivity and quality standards.
• Utilizes appropriate medical and risk resources, adheres to referral policies, and transfers claims to the appropriate risk level in a timely manner.
• Conducts in‑depth pre‑existing condition or contestable investigations as applicable.
• Calculates benefit payments, including 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 respectful, prompt, concise, and accurate customer service in a demanding environment.
• Investigates claims with high complexity within the $1,500 per month approval authority limit.
• Determines eligibility for waiver of premium for life policy up to $125,000.
• Consistently manages an assigned caseload of 60‑80 simple to complex cases independently.
• Collaborates with team members and management to identify and implement improvement opportunities.

• High School Diploma or GED; associate 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 analysis.
• Experience in confidential/protected identification environments.
• Knowledge of medical terminology and good math/calculation skills.
• Ability to work well in a high‑visibility, public‑oriented environment.
• No travel required.

Occasional or frequent standing, walking up to one mile, bending, crouching, kneeling, reaching, occasional lifting up to 25 lbs. Extensive typing and reading. Visual acuity sufficient for data analysis and computer usage; hearing sufficient to understand verbal instruction and answer telephones.

• Annual performance bonus for all team members
• Generous 401(k) company match immediately vested
• Three medical plans with prescription drug coverage
• Company contribution to Health Savings Account for High Deductible Health Plan enrollees
• Dental and vision coverage options
• Company‑provided Life & Disability Insurance
• Paid parental leave and adoption assistance
• Hybrid work arrangements for eligible roles
• Tuition reimbursement and continuing professional education
• Paid time off (at least 20 days for new hires plus 9 paid holidays)
• Volunteer days and community partnerships
• Employee Assistance Program
• Employee Resource Group program access

Collaboration, Compassion, Empowerment, Integrity, Fun

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.

Expected salary range: $52,450.00 – $70,810.00 annually (base pay only). Pay may be modified in the future and may vary by location, skills, experience, qualifications, and market conditions.