At OneAmerica, we deliver on promises when customers need us most. We believe the best way to serve our customers is to know that every individual, employee, family and business we work with has unique personal and financial goals. We keep our promises, so we can help them achieve their goals and realize their definition of financial success.
The STD Claims Examiner is responsible for contributing to the overall success of OneAmerica objectives by providing timely and accurate support to our client companies and the Claims department. This individual will be responsible for managing appropriate adjudication of short-term disability claims in accordance with policy provisions. The STD Claims Examiner will initiate and facilitate case management as well as other ancillary services to assure optimum outcomes.
We are currently seeking Level I, II & Sr. claims experience.
KEY RESPONSIBILITIES:
- Promote a positive customer service image through prompt, accurate and courteous responses to customer information needs
- Consistently adhere to the documented workflow guidelines and established procedures.
- Maintain required levels of confidentiality
- Demonstrate competency in all modules of training program. Remain abreast of industry standards via internal/external continuing education
- Promptly and thoroughly investigate and evaluate claims within departmental and regulatory guidelines
- Interpret and administer contract provisions including, but not limited to, eligibility, covered weekly earnings, definition of Total Disability, verification of applicable offsets and pre-existing investigations
- Calculate benefit and identify other income replacement benefits. Processes financial activities, including, but not limited to, payment adjustments, stop payments, voids and check reissues, other income adjustments, reimbursement checks, and final benefits. Processes overpayments in accordance with established procedures
- Assist in the subrogation process to recover money from third parties
- Work in coordination with an LTD Examiner to ensure an appropriate transition from the STD claim to LTD
- Document claim file actions and telephone conversations appropriately
- Refer claim activity outside authority level to Supervisor/Manager for review
- Proactively communicate with claimants, policyholders and physicians to resolve investigations issues
- Establish, communicate and manage claimant and policyholder expectations
- Utilize most efficient means to obtain claim information
- Fully investigates all relevant claim issues, provides payment or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulations
- Respond to customer service issues within required timeframes
- Involve technical resources (Social Security Specialist, medical resources and vocational resources) at appropriate claim junctures
- Support relationships with technical resources to achieve appropriate outcomes
- Meet or exceed departmental service, quality and production objectives
Collaborate with team members and management in identifying and implementing improvement opportunities. Informs Supervisor of any trends noted within specific client companies
All other duties as assigned
REQUIREMENTS:
- BA/BS or equivalent combination of education and experience
- 2+ years of experience in managing Short Term Disability claims with first pay authority
- Ability to fluently speak and write Spanish a plus
- Excellent customer service skills
- Excellent math and calculation skills
- Good decision making skills – able to analyze complex claim information
- Working knowledge of Microsoft Excel and Word
Salary Band: 03B
As a condition of employment, OneAmerica requires that all new hires who receive a job offer on or after Jan. 17, 2022 provide evidence of vaccination against COVID-19 within the first week of their employment with OneAmerica, unless an exemption has been granted as an accommodation due to the individual's medical condition, sincerely held religious belief, or other legal requirement. Once employment begins, new associates will be required to submit proof of COVID-19 vaccination through the confidential and secure HR Service Center process within their first week of employment. If a new associate is unable to be vaccinated against COVID-19 due to a medical condition or sincerely held religious belief or other legal requirement, the associate will have two weeks after an offer of employment has been accepted to submit a request for an exemption for review and consideration by OneAmerica.
This selected candidate will be expected to work Hybrid in Portland, ME.
If you are offered and accept this position, please be advised that OneAmerica does not have any offices located in the State of New York and OneAmerica associates are not permitted to work remotely in the State of New York.
Disclaimer: OneAmerica is an equal opportunity employer and strictly prohibits unlawful discrimination based upon an individual's race, color, religion, gender, sexual orientation, gender identity/expression, national origin/ancestry, age, mental/physical disability, medical condition, marital status, veteran status, or any other characteristic protected by law.
For all positions:
Because this position is regulated by the Violent Crime Control and Law Enforcement Act, if an offer is made, applicants must undergo mandated background checks as a condition of employment. Such background checks include criminal history. A conviction is not necessarily an absolute bar to employment. Consistent with applicable regulatory guidelines and law, factors such as the age of the offense, evidence of rehabilitation, seriousness of violation, and job relatedness are considered.
To learn more about our products, services, and the companies of OneAmerica, visit oneamerica.com/companies.