Claims Examiner II - SSL

Job Responsibilities Research Develop an understanding and working knowledge of disability and paid family leave. Develop an understanding of the applicable claim definitions and relevant provisions, clauses, exclusions, riders and waivers for the necessary requirements. Develop an operating knowledge of the applicable claims system(s). Develop basic claims skills and an understanding of claim practices and procedures. Utilizes most efficient means to obtain claim information. Analysis and Adjudication Fully investigate all relevant claim issues with oversight by Manager when needed. Provide payment or denials promptly and in full compliance with department procedures and regulations. Research specifics regarding eligibility and pre‑existing formulas in reference to specific claim. Pro‑actively communicate with claimants, policyholders, and physicians when applicable. Case Management Utilize appropriate intervention for the characteristics of each claim. Manage assigned case load and processes within the specified time requirements. Provide good written documentation that is clear, concise, and accurate to claimants and the claims administrative system. Customer Service Provide respectful, prompt, concise, and accurate customer service with competing demands. Establish, communicate, and manage claimant and policyholder expectations. Document claim file actions and telephone conversations appropriately. Handle confidential information with the utmost judgment and discretion. Requirements High school diploma (or equivalent). 1–3 years of New York State statutory Disability and Paid Family leave claims processing experience. Experience with Microsoft Office. Work experience in decision‑making and information analysis. Demonstrated prioritization and organization skills. Clear verbal and written communication skills. Team‑oriented work style. Ability to meet and exceed production, attendance, quality, and service goals. Ability to organize work, manage time, and follow through. Availability for overtime when required. Not required to travel. Physical Requirements Employees may sit for prolonged periods, stand, walk up to one mile, bend, crouch, kneel, reach, and occasionally lift 25 lbs. Extensive typing and use of fingers is required. Visual acuity must be sufficient for preparing and analyzing data, transcribing notes, and viewing a computer terminal. Hearing must be sufficient to understand verbal instruction and answer telephones. Compensation Expected hourly pay range: $25.10 – $31.37 (primary location: Canandaigua, NY). The range covers base pay only and may be modified in the future. Benefits Annual performance bonus for all team members. Generous 401(k) company match immediately vested. Three medical plan options, including prescription drug coverage. Health Savings Account contribution 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 per year plus nine company holidays); PTO may increase with tenure. Volunteer days, community partnerships, and Employee Assistance Program. Employee Resource Group program access. Core Values Collaboration Compassion Empowerment Integrity 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. #J-18808-Ljbffr