Claims Examiner

Recruiter
Matrix Absence Management
Location
Hawthorne
Salary
Competitive
Posted
Jul 17, 2017
Closes
Jul 31, 2017
Industry
Education
Employer Type
Direct Employer
Employment Type
Permanent
Hours
Full Time
Matrix Absence Management is one of the top Third Party Administrators (TPA) supporting clients in absence management (FMLA/Disability/Workers' Compensation). We partner with our clients Human Resources department to manage Workers' Compensation, Disability and/or Leave of absences until the claim is resolved or the employee returns to work. Our highly customer centric approach is to try and duplicate the culture of our clients to make the experience seamless for employees. Our mobile app technology provides ease of use to our client and employee in reporting claim information.
Matrix Absence Management offers a full benefit package- Medical, Dental & Vision, including 401K match. Matrix is a friendly and pleasant office environment; offering flexible schedules M-F.

Position Summary:
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:
  • 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 facilitate 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 customer service, quality and performance objectives.
  • Proactively engages in departmental training to remain current with all claim management practices.
  • Responsible for managing Performance Guarantee clients and meet targeted metrics.
  • Responsible and accountable for maintaining and protecting personal health information. Must maintain a high level of confidentiality and abide by HIPPA rules and regulations.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice.

Education, Qualifications and Experience:
  • Bachelor's degree or equivalent combination of education and experience.
  • 0 2 years leave or disability claim management experience, preferred.
  • Experience with Microsoft Office: Word, Excel is required.
  • Work experience in decision-making and information analysis.
  • Demonstrated prioritization and organization skills.
  • Critical thinking and analytical skills.
  • Ability to communicate clearly and succinctly verbally and in writing
  • Ability to meet deadlines while balancing competing demands.
  • Good math and calculation skills.
AAP/EEO Statement
Matrix Absence Management is an equal opportunity employer applicants are considered for positions without discrimination on the basis of race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, veteran status or any other consideration made unlawful by applicable, federal state or local laws.

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.
Matrix Absence Management is one of the top Third Party Administrators (TPA) supporting clients in absence management (FMLA/Disability/Workers' Compensation). We partner with our clients Human Resources department to manage Workers' Compensation, Disability and/or Leave of absences until the claim is resolved or the employee returns to work. Our highly customer centric approach is to try and duplicate the culture of our clients to make the experience seamless for employees. Our mobile app technology provides ease of use to our client and employee in reporting claim information.
Matrix Absence Management offers a full benefit package- Medical, Dental & Vision, including 401K match. Matrix is a friendly and pleasant office environment; offering flexible schedules M-F.

Position Summary:
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:
  • 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 facilitate 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 customer service, quality and performance objectives.
  • Proactively engages in departmental training to remain current with all claim management practices.
  • Responsible for managing Performance Guarantee clients and meet targeted metrics.
  • Responsible and accountable for maintaining and protecting personal health information. Must maintain a high level of confidentiality and abide by HIPPA rules and regulations.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice.

Education, Qualifications and Experience:
  • Bachelor's degree or equivalent combination of education and experience.
  • 0 2 years leave or disability claim management experience, preferred.
  • Experience with Microsoft Office: Word, Excel is required.
  • Work experience in decision-making and information analysis.
  • Demonstrated prioritization and organization skills.
  • Critical thinking and analytical skills.
  • Ability to communicate clearly and succinctly verbally and in writing
  • Ability to meet deadlines while balancing competing demands.
  • Good math and calculation skills.
AAP/EEO Statement
Matrix Absence Management is an equal opportunity employer applicants are considered for positions without discrimination on the basis of race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, veteran status or any other consideration made unlawful by applicable, federal state or local laws.

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.