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Integrated Claims Examiner

March 03, 2013 - May 15, 2014
Location:PHOENIX, AZ
Exempt/Non-Exempt:Exempt
Benefits:Full Benefits, PTO, 401
Employment Type:Full Time
Department:Short Term Disability
Description:The Integrated Claims Examiner (Short Term Disability) will act as a liaison between client, employee and 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 Claims Examiner within the Matrix tracking system.
Duties:• Investigate, evaluate and determine benefit eligibility of Short Term Disability 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/FMLA.
• 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.
• PC skills preferred (i.e. Windows based environment).

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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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