Long-Term Disability Claims Examiner

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 Examiner is responsible for obtaining and analyzing information in order to make claim decisions and payments on disability claims. This role develops and applies appropriate claim and disability management techniques to ensure prompt and accurate payment and liability management of disability claims. The LTD Claims Examiner provides responsive customer service to claimants, policyholders, brokers, and internal departments.

We are currently seeking Level I, II & Sr. claims experience.

What you will do:

• Complete the Employee Development Disability Policy Knowledge and Claim Adjudication course.
• Promptly and thoroughly investigate claims within departmental and regulatory guidelines.
• Interpret and administer contract provisions including, but not limited to, eligibility, covered monthly earnings, definition of Total Disability, verification of applicable offsets and pre-existing investigations.
• Develop, implement and modify disability management plan to establish strategy and manage outcome.
• Document claim file actions and telephone conversations appropriately.
• Participate in departmental Focus Reviews.
• Identify and investigate change in Total Disability definition (any occ).
• Refer claim activity outside authority level to Supervisor/Manager for review.
• Pro-actively communicate with claimants, policyholders, and physicians to resolve investigations issues.
• Establish, communicate and manages claimant and policyholder expectations.
• Utilize most efficient means to obtain claim information.
• Fully investigate all relevant claim issues, provide payment or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulations.
• Respond to customer service issues within required timeframes to meet customer expectations.
• Involve technical resources (Social Security Specialist, medical resources, vocational resources) at appropriate claim junctures.
• Support relationships with technical resources to achieve optimal financial outcomes.
• Actively contribute to departmental service, quality and financial objectives.
• Remain current with all corporate and disability management practices.
• Collaborate with team members and management in identifying and implementing improvement opportunities.

REQUIREMENTS:

• BA/BS or equivalent combination of education and experience.
• 3 years of experience with LTD disability claims ideal
• Experience with computer applications – Word, Excel desired.
• Work experience in decision-making and information analysis.
• Ability to meet deadlines while balancing competing demands.
• Good math and calculation skills.

Salary Band: 3C

#LI-SH1

#LI-Hybrid

This selected candidate will be expected to work hybrid in South Portland, ME. 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 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.

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.