- Investigates claim issues providing resolution within departmental and regulatory guidelines.
- Interprets and administers contract provisions: eligibility and duration.
- Accurately codes all system fields with correct financial, diagnosis and duration information.
- Coordinates with other departments to ensure appropriate claims transition or facilitates timely return to work.
- Document claim updates in the claim database ensuring accuracy.
- Maintaining departmental and policyholder expectations.
- Adheres to compliance, departmental procedures, and Unfair Claims Practice regulations.
- Actively contributes to, and maintains, customer service, quality and performance objectives.
- Proactively engages in departmental trainings to remain current with all claim management practices.
- Responsible for managing Performance Guarantees for assigned clients, and meet targeted metrics.
- Responsible and accountable for maintaining and protecting personal, confidential claimant health information. Must maintain a high level of confidentiality and abide by HIPPA rules and regulations.
- Other responsibilities may be assigned as needed.
- Strong communication skills both written and verbal. Willingness to communicate regularly with claimants, clients, and intercompany colleagues across the organization as needed.
- Desire to work in a fast-paced, energetic environment, in a customer-facing role.
- Ability to act with empathy and care in all interactions on a daily basis.
- Ability to synthesize and analyze data and information.
- Ability to complete assigned tasks and projects in a timely manner, adhering to deadlines.
- Must maintain prompt and consistent, predictable attendance, with ability to work assigned daytime shifts 5 days per week. Ability to work overtime as business demands.
- Ability to interact with employees of all levels and clients in an appropriate manner.
- Ability to concentrate and remain focused on tasks throughout the day and think strategically.
- 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
- Integrity
- Empowerment
- Compassion
- Collaboration
- Fun
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Absence Management Specialist- Hybrid Position - Portland, United States - Matrix Absence Management
Description
Job Responsibilities and RequirementsHybrid Position- 2 days in the office, 3 days remote.
Position Summary
Are you looking for a new career ? Do you love helping people ? Do you love working in a fast-paced, exciting environment , where you'll also get to learn an industry that is hugely important to our everyday lives? If you answered yes to these questions, you are in luck Matrix is one of the top TPA firms in the country and is growing
What is a TPA firm, you ask? ~ Third Party Administrators work on behalf of other organizations when they have a lot of employees or details to manage.
In our world, we help other employers manage their Disability Claims when an employee gets sick, injured, has a baby, needs a surgery, or something similar that will require them to be out of work for a while.
You can imagine this time in someone's life can either be really terrifying or really exciting Either way - it's usually not something they're experts at - and that's where you come in: to walk them through the process of handling their care, and returning to work.
For YOU as someone new to the claims world, we offer a full comprehensive 8-week training program that will prepare you for everything you will need to be successful in this role.
The details of the day to day are in the description below, read through them, and then apply and talk to one of our friendly recruiters.
We will walk you through the process, much like you will do for our customersPosition Overview:
The Claims Examiner will act as a liaison between client, employee and healthcare provider.
In this position, you are responsible for applying appropriate claims management by providing reliable and responsive service to claimants and clients.
Duties and Responsibilities:
Essential Job Requirements:
Demonstrated proficiency in using a personal computer for routine tasks such as email (Outlook), reports (Excel), and general aptitude to learn proprietary disability software platforms.
Ability to complete, or oversee the completion of, assigned tasks/projects in a timely manner
* #LI-Hybrid
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:
Our Values:
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.#LI-Hybrid
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