Matrix Absence Management
  • 23-Aug-2017 to 22-Sep-2017 (MST)
  • Integrated Claims Management
  • Santa Clara, CA, USA
  • Hourly
  • Full Time

Full Benefit Package


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 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.

We offer a full benefit package including medical, dental & vision, including a dollar for dollar 401K match, and a generous amount of paid time off.  Our work schedule is flexible Monday- Friday and many positions allow some flexibility in work hours.  We offer a friendly & pleasant office environment where you will be a part of a dedicated team supporting major clients. 

 

Position Summary

This position is accountable for the decision making process for determining eligibility under federal, state laws and client policy. Secure and analyze information to make and approve decisions on all short term disability, insured or self-insured, and/or statutory claims and their concurrent leave claims. Develop and apply appropriate claim and workflow management strategies, coordinating both disability and leave decisions while meeting timeliness regulations.

Duties:

  • 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 
  • Fully Investigates all relevant issues, providers, payments 
  • All other duties as assigned.

Qualifications:

  • College degree preferred or an equivalent of at least three years of work experience
  • 1-2 years experience in a claims environment
  • Knowledge of federal and state laws pertaining to leaves of absence
  • Knowledge of medical terminology preferred
  • Basic knowledge of ERISA preferred
  • Professional written and verbal communication and interpersonal skills
  • Strong reading, writing, and arithmetic skills required
  • Ability to interpret and administer policy/plan provisions 
  • Ability to calculate earnings and benefit levels 
  • Ability to gather, analyze and organize data to make educated decisions
  • Ability to identify critical issues and exercise independent judgment
  • Proficient in the use of Microsoft programs; Excel and Word
  • Typing proficiency at 45 wpm 
  • Experience using web based programs 

Additional qualifications:

  • Excellent math, verbal and business writing skills, good reading comprehension.
  • Ability to organize work, manage time and follow through.
  • Ability to communicate effectively, both orally and in writing. 
  • Proven experience in providing internal and external customer service. 
  • Ability to handle confidential information with the utmost judgment and discretion.
Matrix Absence Management
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