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 Monday-Friday.
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.
*This is a remote position offered to candidates nationwide.
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
Essential Physical/Cognitive Job Functions:
- Prompt and regular attendance at assigned job locations
- Ability to work shifts exceeding 8 hours, 5 days per week
- Ability to interact with employees of all levels and clients in an appropriate manner
- Ability to concentrate and think strategically
- Availability onsite to confer with staff members with whom the incumbent must interact on a daily basis
- Ability to proficiently use a personal computer for tasks such as email and preparing reports using software
- Ability to review and analyze data and information
- Ability to complete, or oversee the completion of, assigned tasks/projects in a timely manner
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.
Matrix Absence Management 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 with Matrix depends solely on your qualifications.