LTD Claims Assoc Sr

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 Long Term Disability (LTD) Claims Associate is responsible for contributing to the overall success of OneAmerica's objectives by providing timely and accurate support to our customers and the claims department. This individual will analyze information in order to make claim decisions and payments on disability claims. The LTD Claims Associate develops and applies appropriate claim and disability management techniques to ensure prompt and accurate payment and liability management of disability claims. This role provides responsive customer service to claimants, policyholders, brokers, and internal departments. This individual is also responsible for helping our customers maintain a sense of security and their well-being by independently and effectively managing an assigned caseload of claims, in a fair and ethical manner.

KEY RESPONSIBILITIES:

• Adjudication of claims.
• Provide quality claim decisions, timely and accurate benefit payments in accordance with the policy/contract provisions, regulations and claim procedures for complex claims.
• Appropriately and independently use problem solving measures and discretion to investigate complex claims by utilizing investigative tools such as clinical and vocational team consults and referrals, independent peer reviews, medical examinations, motor vehicle reports, activity/investigations, surveillance, etc.
• Conduct proactive, empathetic, knowledgeable, thoughtful communications with internal and external customers.
• Identify, understand and appropriately refer matters to legal counsel, accounting, or escalates claim issues with minimal oversight from the leadership team.
• Actively deliver results by contributing to achieving and maintaining or exceeding departmental deadlines, requirements, service, accuracy, timeliness, and performance standards.
• Conduct effective and relationship building interviews that contain probing questions with all appropriate parties including claimant or their representative, policyholder, medical provider, attorneys obtain and reveal all claim facts, the root of a claim issue/problem, or to resolve a customer issue.

REQUIREMENTS:

• High School Diploma or GED required
• Bachelor's Degree preferred in Business Management, Operations Management, Statistics, or Insurance.
• Minimum of 2+ years’ work experience required.
• Knowledge of medical terminology is preferred, but not required.
• LOMA, ICA ideal
• Prior experience within a claim operation required.
• Customer Service, and experience working with Microsoft applications. Excellent in Math.
• Good decision-making skills- able to analyze complex information.
• Or any combination of education and experience which would provide an equivalent background

Salary Band: 04B

The selected candidate will be expected to work Hybrid in Portland, ME if local. Will consider remote options for candidates who are not local to 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.