This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Manager, Medical Claims, is responsible for leading the end‑to‑end process of preparing, validating, and submitting stop‑loss claims to ensure timely and accurate reimbursement for high‑cost medical claims. This role oversees daily team operations, establishes workflow and quality standards, and collaborates with internal and external parties to resolve issues and optimize outcomes. - Lead, coach, and develop a team of Stop Loss Filing Specialists and Analysts. - Oversee day‑to‑day workflow management, ensuring timely assignment, processing, and submission of all stop loss claims. - Establish performance standards, quality controls, and productivity expectations. - Provide ongoing training to ensure staff expertise in stop‑loss processes, coordination of benefits (COB), and claim documentation requirements. - Manage the complete lifecycle of specific and aggregate stop‑loss filings, including claim preparation, eligibility verification, documentation assembly, and carrier submission. - Audit claims against plan document, stop loss contract, and carrier standards. - Facilitate financing of approved claims with finance. - Pend claims and issue denials to third party administrator where appropriate. - Elevate complex claim issues for clinician or management review. - Compile periodic reporting for internal and external parties. - Advise on claim projections and development. - Develop and maintain standardized filing procedures, policies, and best practices. - Perform self-quality monitoring to develop and execute plans to meet established goals. - Identify process gaps and lead continuous improvement initiatives to increase accuracy, speed, and reimbursement rates. - Collaborate with peers and cross-departmentally to improve or streamline procedures. Qualifications - High School Diploma or GED. - Associate degree in Business Administration, Healthcare Administration, Finance, or a related field. - An equivalent combination of education and relevant stop‑loss or claims experience may be considered in place of a degree, depending on organizational policy. - 2-3 years of team leadership or supervisory experience. - Excellent analytical skills, attention to detail, and problem‑solving ability. - Strong communication skills with experience managing external partner relationships. - 8+ years of experience in stop loss insurance, medical claims, health plan operations, or related field. Benefits - Multiple Health Plan Options, including a 100% Employer Paid Benefit Options. - 100% Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance. - Parental Leave Policy. - 20 days PTO to start / 10 Paid Holidays. - Tuition reimbursement. - 401k Company contribution. - Professional development initiatives / continuous learning opportunities. - Opportunities to participate in and support the company's diversity and inclusion initiatives.

Job Responsibilities and Requirements KEY RESPONSIBILITIES *other duties as assigned* The Claims Examiner I obtains and analyzes data for thorough, fair, objective, and timely processing of New York State statutory Short-Term Disability and Paid Family leave claims. The goal of the position/role is to consistently pay the accurate amount for each claim in accordance with the current laws/regulations. Research Develop an understanding and working knowledge of disability and paid family leave Develop an understanding of the applicable claim definitions and relevant provisions, clauses, exclusions, riders and waivers for the necessary requirements. Develop an operating knowledge of the applicable claims system(s). Develop basic claims skills and an understanding of claim practices and procedures. Utilizes most efficient means to obtain claim information. Analysis and Adjudication Fully investigates all relevant claim issues with oversight by Manager when needed. Provides payment or denials promptly and in full compliance with department procedures and regulations. Researches specifics regarding eligibility and pre-existing formulas in reference to specific claim. Pro-actively communicates with claimants, policyholders, and physicians when applicable Case Management Utilizes appropriate intervention for the characteristics of each claim. Manages assigned case load and processes within the specified time requirements. Good written documentation that provides clear, concise and accurate information to claimants as well as within the claims administrative system. Customer Service Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands. Establishes, communicates, and manages claimant and policyholder expectations. Documents claim file actions and telephone conversations appropriately. Ability to handle confidential information with the utmost judgment and discretion REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR RELATED EXPERIENCE *or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience* Required Knowledge, Skills, Abilities and/or Related Experience High school diploma (or equivalent) Must have 1-3 years of New York State statutory Disability and Paid Family leave claims processing experience to be considered for this role. Experience with Microsoft Office Work experience in decision-making and information analysis. Demonstrated prioritization and organization skills. Ability to communicate clearly and succinctly verbally and in writing Must be able to work in a team oriented environment. Meet and exceed production, attendance, quality and service Ability to organize work, manage time and follow through Availability to work overtime when required Ability to Travel: None PHYSICAL REQUIREMENTS When used in the description below, the following terms are defined as: “Occasional”: done only from time to time, but necessary when it is performed “Frequent”: regularly performed; generally an act that is required on a daily basis “Continuous”: typically performed for the majority of an employee’s shift Sitting for prolonged periods of time, frequently standing, walking distances up to one mile, bending, crouching, kneeling, reaching, occasionally lifting 25lbs, extensive typing, picking up and holding small objecting and otherwise using primarily the fingers rather than the entire hand.  Employee is required to have visual acuity sufficient to perform activities such as preparing and analyzing data and figures; transcribing notes; viewing a computer terminal and extensive reading. Employee is required to have hearing sufficient to understand verbal instruction and answer telephones.  Reliance Matrix will provide qualified employees with a reasonable accommodation in accordance with applicable law. CORE VALUES Collaboration Compassion Empowerment Integrity Fun The above description reflects the general details considered necessary to describe the principle responsibilities and functions of the job identified and shall not be construed as a detailed description of all the work requirements that may be inherent to this job. The expected hiring range for this position is $22.41 - $28.02 hourly for work performed in the primary location (Canandaigua, NY). This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate’s starting base pay will be based on several factors including work location, job-related skills, experience, qualifications, and market conditions. These ranges may be modified in the future. Work location may be flexible if approved by the Company. What We Offer At Reliance Matrix, we believe that fostering an inclusive culture allows us to realize more of our potential. And we can’t do this without our most important asset—you. That is why we offer a competitive pay package and a range of benefits to help team members thrive in their financial, physical, and mental wellbeing. Our Benefits: An annual performance bonus for all team members Generous 401(k) company match that is immediately vested A choice of three medical plans (that include prescription drug coverage) to suit your unique needs.  For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account Multiple options for dental and vision coverage Company provided Life & Disability Insurance to ensure financial protection when you need it most Family friendly benefits including Paid Parental Leave & Adoption Assistance Hybrid work arrangements for eligible roles Tuition Reimbursement and Continuing Professional Education Paid Time Off – new hires start with at least 20 days of PTO per year in addition to nine company paid holidays.  As you grow with us, your PTO may increase based on your level within the company and years of service. Volunteer days, community partnerships, and Employee Assistance Program Ability to connect with colleagues around the country through our Employee Resource Group program Our Values: Integrity Empowerment Compassion Collaboration Fun EEO Statement Reliance Matrix 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 depends solely on your qualifications. #LI-Remote #LI-AS1

• Maintain oversight of commercial claims including complex and litigated matters • Perform second- and third-level reviews • Validate coverage, liability, reserves, and settlement strategies • Provide direction to TPAs, adjusters, and counsel • Perform file audits and QC checkpoints, track SLAs, cycle times, litigation rates, and recoveries • Support internal and external audit and develop remediation plans • Conduct routine claims audits and quality reviews • Develop and maintain claims dashboards to track trends, performance metrics, and program health • Partner cross-functionally with Athlete Safety to share claims data, loss trends, and emerging risk insights • Analyze claim outcomes across TPAs, jurisdictions, and programs to inform process improvements and underwriting insights • Submit GL and A&H claims and manage ongoing communication with TPAs • Support MGA financial and regulatory reporting, including carrier-specific and state-required submissions • Lead data cleanup initiatives across MGA and claims systems to improve reporting accuracy • Lead, mentor, and develop a growing team by establishing clear standards, workflows, and accountability

• Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees • Initiates timely contact with insureds and claimants to explain the claim process and initiate the investigation • Obtains statements from insureds, claimants, and witnesses and documents summaries within the claims system • Request and analyze investigative and other relevant reports, claim forms and documents when appropriate • Documents claim activities, reserve analysis, and summaries of reports including Medicare (MSP) modules in the claim system • Sets timely, adequate reserves in compliance with the company reserving philosophy and methodology • Identifies, investigates, and proactively pursues opportunities for recovery including arranging of evidence preservation in legal compliance that meets custody, control, transfer, analysis, and disposition of physical and/or electronic evidence • Adheres to all state requirements regarding regulatory compliance by sending out letters/forms containing appropriate language according to timelines • Reviews bills, invoices and receipts for accuracy and appropriateness • Notifies people leader of claims that may need escalation or reassignment • Drafts reservation of rights and coverage denial letters with supervisor approval • Assigns vehicle/property damage appraisals and vehicle rentals • Makes recommendations to people leader on the assignment of independent adjusters • Provides prompt, detailed responses to agents, insureds, and claimants on the status of claims • Resolves questions of coverage, liability and the value of the claims and communicates with insureds and claimants to resolve claims in a timely manner • Prepares bodily injury and/or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation. Obtains authority when required • Identifies and protects all liens as appropriate • Investigates Medicare liens and resolves issues in accordance with EMC and Medicare guidelines • Communicates with insureds, claimants, and attorneys to negotiate the settlement of claims • Prepares and issues settlement and release documents verifying accuracy and ensuring they are properly executed • Issues timely payments • Reviews and audits estimates written by independent adjusters for accuracy and to ensure the most cost-effective repair approach • Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units and Claims Legal teams as appropriate • Prepares risk reports for Underwriting and Risk Improvement • Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage and damage