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Integrated Claims Examiner

October 03, 2013 - December 13, 2013
Location:PHOENIX, AZ
Exempt/Non-Exempt:Exempt
Benefits:FULL BENEFITS PACKAGE
Employment Type:Full Time
Department:Integrated Claims Management
Description:The Integrated Claims Examiner (Disability/LOA) will act as a liaison between client, employee and the healthcare provider. This position is accountable for the decision making process for determining eligibility under federal, state laws and client policy.

Documentation, medical certification and leave tracking will be managed by the Integrated (LOA) Claims Examiner within the Matrix tracking system.
Duties:• Investigate, evaluate and determine benefit eligibility of Disability/LOA claims in a timely fashion.
• Determine eligibility under federal and state requirements for leaves submitted.
• Medical certification review and management supplied by the healthcare provider.
• Determine the duration associated with the leave based on the information given by the healthcare provider.
• Communicate approvals, denials, leave extensions, return to work plans and other important information regarding the claim to the employee and client.
• Manage leaves that are concurrent with Short Term Disability and Workers’ Compensation.
• Manage intermittent, continuous and client specific leaves of absences.
• Process all absences within the specific timeframes outlined within Matrix Best Practices guidelines.

Other duties as assigned.
Qualifications:• 3+ years of disability claims administration or industry experience.
• Bachelors degree preferred
• Knowledge of ERISA regulations and Self Insured Disability Plans.
• Ability to manage the medical aspects of a claim from onset to return to work, utilizing industry standard tools and strategies.
• Working knowledge of Federal and State Leave Laws.
• Excellent organizational and time management skills.
• Strong written and communication skills demonstrated in previous work experience.
• Specific experience with collaborative negotiations.
• Proven skills in positive and effective interaction with challenging customers.
• Experience in effectively meeting/exceeding individual professional expectations and team goals.
• Demonstrated analytical and math skills.
• Ability to exercise sound judgment.
• High level of flexibility to adapt to the needs of the organizations.

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Matrix Absence Management is a nationwide company that partners with employers to provide customized management of disability, workers’ compensation and family leave programs.

We service a wide range of nationwide clients. Our clients include Fortune 500 companies, Technology sector leaders, Service Companies, Manufactures, Bio Tech, Utilities and Healthcare.


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