Matrix Absence Management
  • 09-Aug-2017 to 08-Sep-2017 (MST)
  • Integrated Claims Management
  • Hawthorne, NY, USA
  • DOE
  • Salary
  • Full Time

Full Benefit Package- Medical, 401K, PTO


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 II, AMS (Absence Management Specialist) is responsible for developing and applying appropriate claim and workflow management strategies, coordinating both disability and leave decisions while meeting timeliness regulations. The use of sound judgment is coupled with consistent results is expected. The ability to independently analyze, evaluate, manage and adjudicate moderate complex claims.

 

Duties and Responsibilities:

  • Determines eligibility under federal and state requirements for leaves submitted and determines eligibility under client's plan/policy.  
  • Responds to customer service issues within required timeframes.       Pro-actively communicates decisions within Best Practice guidelines, consistently meeting Performance Guarantee requirements.
  • Makes determinations to approve, deny or delay and or reach out to additional resources for review, based on medical certification review and management.
  • Determines the duration associated with the leave and or disability based on the information given by the healthcare provider.
  • Communicates approvals, denials, leave extensions, return to work plans and other important information regarding the leave to the employee and client.      
  • Manages leaves that are concurrent with Short Term Disability and Workers' Compensation.
  • Manages intermittent, continuous and client specific leaves of absences.      
  • Facilitates issue resolution and draw on expertise of internal partners as needed.      
  • Fully investigates all relevant issues, providers, payment or denials, promptly and in full compliance with departmental procedures and unfair claims practice and regulations.
  • Manages self insured Self insured business in accordance with clients plans and custom requirements
  • Accurately and thoroughly document claim file actions and conversations
  • Document claim updates in the claim database ensuring accuracy.
  • Responsible and accountable for maintaining and protecting personal health information. Must maintain a high level of confidentiality and abide by HIPPA rules and regulations.
  • Process medium to high complexity or technically difficult claims.
  • Develops and manages claims thought well developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution. 

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: 

  • College degree or equivalent combination of direct absence management experience
  • Strong knowledge of leave or disability and claim management experience, a must
  • Proven ability to manage multiple lines of business; previous industry case management experience
  • Experience with Microsoft Office: Word, Excel is required
  • Work experience in decision-making and information analysis.
  • Knowledge of medical terminology preferred. 
  • Demonstrated prioritization and organization skills.
  • Critical thinking and analytical skills: Ability to interpret and administer policy/plan provisions.
  • Ability to communicate clearly and succinctly verbally and in writing.
  • Ability to meet deadlines while balancing competing demands.
  • Good math and calculation skills: Ability to calculate earnings and benefit levels.
  • Experience using web based programs

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.

 

Matrix Absence Management
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