LTD Claims Examiner II
Reliance Standard, South Portland, ME, United States
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. 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.
Analysis and Adjudication
Fully investigates and adjudicates a large volume simple to complex claims.
Identifies and investigates change in Total Disability definition (any occ).
Independently reviews and manage claims with high degree of complexity within the $1,500 per month approval authority limit.
Independently makes the determination if a policyholder with life policy up to $125,000 is eligible for a waiver of premium.
Majority of work is not subject to supervisor review and approval.
Case Management
Consistently manage assigned case load of 60-80 simple to complex cases independently.
Collaborates with team members and management in identifying and implementing improvement opportunities.
Required Knowledge, Skills, Abilities 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 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.
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
Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objecting and otherwise using primarily the fingers rather than the entire hand. Employee is required to have visual acuity sufficient to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones. Reliance Matrix will provide qualified employees with a reasonable accommodation in accordance with applicable law.
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.
The expected hiring range for this position is $52,450.00 - $65,570.00 annually for work performed in the primary location (South Portland, ME). 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 fostering an inclusive culture allows us to realize more of our potential. And we can't do this without our most important assetyou.
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 new hires start with at least 20 days of PTO per year in addition to nine company paid holidays. As you grow with us, your PTO may increase based on your level within the company and years of service.
Volunteer days, community partnerships, and Employee Assistance Program
Ability to connect with colleagues around the country through our Employee Resource Group program
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.
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. 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.
Analysis and Adjudication
Fully investigates and adjudicates a large volume simple to complex claims.
Identifies and investigates change in Total Disability definition (any occ).
Independently reviews and manage claims with high degree of complexity within the $1,500 per month approval authority limit.
Independently makes the determination if a policyholder with life policy up to $125,000 is eligible for a waiver of premium.
Majority of work is not subject to supervisor review and approval.
Case Management
Consistently manage assigned case load of 60-80 simple to complex cases independently.
Collaborates with team members and management in identifying and implementing improvement opportunities.
Required Knowledge, Skills, Abilities 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 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.
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
Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objecting and otherwise using primarily the fingers rather than the entire hand. Employee is required to have visual acuity sufficient to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones. Reliance Matrix will provide qualified employees with a reasonable accommodation in accordance with applicable law.
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.
The expected hiring range for this position is $52,450.00 - $65,570.00 annually for work performed in the primary location (South Portland, ME). 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 fostering an inclusive culture allows us to realize more of our potential. And we can't do this without our most important assetyou.
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 new hires start with at least 20 days of PTO per year in addition to nine company paid holidays. As you grow with us, your PTO may increase based on your level within the company and years of service.
Volunteer days, community partnerships, and Employee Assistance Program
Ability to connect with colleagues around the country through our Employee Resource Group program
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.