At OneAmerica Financial, our purpose is to create more certainty for our customers that leads to better moments, every day. Our commitment is to advance stability and growth in every solution and relationship. We deliver financial strength that builds for generations, and we are always aspiring, looking ahead, and collaborating to achieve more, together. Come be a part of this journey with us as we champion lives!
Job Summary
Responsible to contribute to the overall success of OneAmerica's objectives by providing timely and accurate support to our customers and the claims department. To obtain and analyze information in order to make claim decisions and payments on disability claims. To develop and apply appropriate claim and disability management techniques to ensure prompt and accurate payment and liability management of disability claims. To provide responsive customer service to claimants, policyholders, brokers, and internal departments. 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.
Primary duties may include, but are not limited to:
- The LTD Claims Associate is responsible for the adjudication of more complex claims as well as training and mentoring less experienced associates. This role is responsible for providing quality claim decisions, timely and accurate benefit payments in accordance with the policy/contract provisions, regulations and claim procedures for complex claims. They 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.
- Expected to conduct proactive, empathetic, knowledgeable, thoughtful communications with internal and external customers. Identifies, understands, and appropriately refers matters to legal counsel, accounting, or escalates claim issues with minimal leadership consultation. Actively delivers results by contributing to achieving and maintaining or exceeding departmental deadlines, requirements, service, accuracy, timeliness, and performance standards.
- Proficient at conducting 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.
- Performance and Service expectations: 50%
- Actively delivers results and contributes to and maintains or exceeds departmental deadlines, requirements, service, accuracy, timeliness, and performance standards. The LTD Claims Associate Senior will take appropriate action to achieve objectives and will independently adjust actions and assist fellow associates in response to shifting priorities and rapid change. Completes correct accounting transactions and clearing according to departmental procedures.
- Customer Experience and support 40%
- Effectively, accurately and timely communicates and collaborates with internal and external customers in accordance with departmental customer service protocols.
- Demonstrates ability to independently investigate, collect, examine, claim or accounting information, to determine claim or accounting direction and make accurate, impartial, and quality claim determinations in accordance with claim facts, policy/contract provisions, regulations, and department procedures, for claims of complex nature.
- Appropriately and independently uses critical thinking, problem solving measures and discretion to investigate complex claims by utilizing investigative tools such as independent peer reviews, medical examinations, autopsies, toxicology reports, activity/death investigations, surveillance, etc. Correctly calculates and processes claim benefit payments due within authority level, in compliance with policy/contract provisions, regulations, and department procedures. Prepares quality communication to agents, policyowners, insureds, beneficiaries, policyholders, medical providers, or other customer and business relationship parties. The Claims Associate will be able to identify, understand, and appropriately refer matters to legal counsel or escalates claim issues with minimal leadership consultation.
- Demonstrates the flexibility to perform other duties and projects as assigned, including but not limited to complex projects, authority and random quality audits of less experienced claim associates, etc. Actively leads by example when coaching, mentoring, and assisting less experienced associates.
- Process Improvement 10%
- Demonstrate EWA and support of the OneAmerica Ways.
- Identify opportunities for efficiency and innovation in process and communicate to leadership team.
Job Requirements
Required Education and/or Certifications
- High School Diploma or GED
Recommended Education and/or Certifications
- Bachelor's Degree preferred in Business Management, Operations Management, Statistics, or Insurance.
- LOMA, ICA
Required Work Experience
- Prior experience within a claim operation required. Minimum of 4 years’ work experience required.
- Customer Service, and experience working with Microsoft applications.
- Or any combination of education and experience which would provide an equivalent background
Salary Band: 04B
This selected candidate will be expected to work remote; if local to Portland, Maine the selected candidate will work a Hybrid schedule. The candidate will also be expected to physically return to the office in CA, IN or ME as business needs dictate or for team-building and collaboration.
If you are offered and accept this position, please be advised that OneAmerica Financial does not have any offices located in the State of New York and OneAmerica Financial associates are not permitted to work remotely in the State of New York.
Disclaimer: OneAmerica Financial 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 Financial, visit oneamerica.com/companies.