LTD Claims Examiner Sr.

Position Summary Essential Functions & Qualifications Summary Job Description Summary Duties and Responsibilities: 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 polices, 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, cost of living adjustments, etc. Develops and maintains on-line claim data (and paper file if applicable). Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands. 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 Independently manages assigned case load as outlined in LTD Key Measures Collaborates with team members and management in identifying and implementing improvement opportunities. Miscellaneous Remains current with all corporate and disability management practices. Collaborates with team members and management in identifying and implementing improvement opportunities. Collaborates with management on claims with high degree of complexity. Any other job-related duty as deemed appropriate by management. Additional Job Description EEO Statement Matrix Absence Management 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 with Matrix depends solely on your qualifications.