Claims Examiner I, AMS – Matrix Absence Management – Portland, OR

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 I, AMS (Absence Management Specialist) is responsible for securing and analyzing information to make and approve decisions on all short term disability, insured or self-insured, and/or statutory claims and their concurrent leave claims. The ability to independently analyze, evaluates, manages and adjudicates claims.

Essential Functions:

  • 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.

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 an equivalent of at least three years of work experience
  • Knowledge of leave or disability and claim management experience
  • Ability to organize work, manage time and follow through.
  • 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
  • Ability to handle confidential information with the utmost judgment and discretion.

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.

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.


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