Claims Examiner I - Supplemental Health

Job Responsibilities and Requirements Key Responsibilities: *other duties as assigned* Analysis and Adjudication Reviews and processes Wellness, Accident, Critical Illness, or Hospital Indemnity claim documents and proofs to verify eligibility based on contractual provisions and premium status within company guidelines and applicable law. Authorizes claim payments up to $5,000. Determines proper payee, verifies the accuracy of benefit amount calculations, and any applicable interest calculations and processes benefit payments. Processes system tasks and pending claims in accordance with department guidelines. Provides payment or denials promptly in full compliance with department procedures and regulations. Research Develops an understanding and working knowledge of products, policies and contracts. Develops an understanding of the applicable contract/policy definitions of disability and relevant provisions, clauses, exclusions, as well as statutory requirements. Reviews medical and applicable information to verify eligibility. Determines proper payee, verifies the accuracy of benefit amount calculations, premium amount calculations under contributory plans, and any applicable interest calculations. Fully investigates all relevant claim issues. Case Management Provides clear, concise and accurate information to claimants as well as within the claims administrative system. Creates necessary correspondence for benefit denials, partial denials, or eligibility denials. Manages assigned case load as outlined in Key Measures. Requests any necessary additional information from the policyholder and medical providers, or vendors when needed. Utilizes most efficient means to obtain claim information. Customer Service Provides customer service that is respectful, prompt, concise, and accurate in an environment with competing demands. Establishes, communicates, and manages claimant and policyholder expectations. Documents claim file actions and telephone conversations appropriately. Qualifications High School Diploma or equivalent required; relevant Associate’s or Bachelor’s Degree highly preferred. Minimum of one (1) year related claims experience preferred. Work experience in decision‑making and information analysis. Excellent communication skills. Demonstrated prioritization and organization skills. Experience working in confidential/protected identification environments. Good math and calculation skills. Proficient in Microsoft Office products. Prior experience using an automated claim system desirable. Physical Requirements Sitting for prolonged periods; frequently standing, walking up to one mile, bending, crouching, kneeling, reaching. Occasionally lifting 25 lbs. Extensive typing and handling of small objects. Visual acuity sufficient to read computer terminal, transcribe notes, and analyze data; hearing sufficient to understand verbal instructions and answer phones. Compensation The expected hiring range for this position is $19.25 – $25.98 hourly. This range covers only base pay and excludes any other compensation components such as commissions or incentive awards. Benefits Annual performance bonus for all team members Generous 401(k) company match immediately vested Choice of three medical plans, including coverage of prescription drugs Company contribution to Health Savings Account for High Deductible Health Plan enrollees Multiple options for dental and vision coverage Company provided Life & Disability Insurance 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 per year plus nine company paid holidays Volunteer days, community partnerships, Employee Assistance Program Employee Resource Group program Equal Employment Opportunity 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 Reliance Standard Life Insurance Company