LTC Claims Associate

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 for helping our customers maintain a sense of security by independently and effectively managing an assigned caseload of claims, in a fair and ethical manner and within all requirements and service standards.

Claim Associate II is responsible for:

• Reviewing an processing the more complex claims (i.e. Contestable claims)
• Clearing outstanding accounting
• Clearing up eligibility issues
• Performing adjustments
• Training, mentoring, and auditing less experienced associates.
• Escalating claim issues with minimal leadership consultation.
• Taking on escalated calls

Primary duties may include, but are not limited to:

• Customer Experience and support 40%
  • Effectively, accurately, and timely communicate/collaborate with internal and external customers in accordance customer service protocols.
  • Independently investigate, collect, examine information to determine claim direction to make accurate, impartial claim determinations based on facts, policies, regulations, and department procedures, for claims including those of a complex nature.
  • Appropriately and independently use problem solving measures and discretion to investigate claims by utilizing appropriate investigative tools.
  • Correctly calculates and processes claim benefit payments due within authority level.
  • Prepares quality communication to agents, policy owners, insureds, beneficiaries, policyholders, medical providers, or other customer and business relationship parties.
  • Identify, understand, and appropriately refer matters to legal counsel or escalates claim issues with minimal leadership consultation.
• Performance and Service expectations: 50%
  • Maintains or exceeds departmental deadlines, requirements, service, accuracy, timeliness, and performance standards. Completes correct accounting transactions and clearing according to departmental procedures.
• Process Improvement 10%
• Demonstrate EWA and support of the OneAmerica Ways.

Job Requirements

Required Education and/or Certifications

• High School Diploma or GED. Bachelor's Degree preferred in Business Management, Operations Management, Statistics, or Insurance. Prior experience within a claim operation is preferred. Knowledge of insurance administration terms and processes are a plus. Recommended Education and/or Certifications
• LOMA

Required Work Experience

• Desired minimum of 2-4 years’ work experience.
• Customer Service, and experience working with Microsoft applications
• Or any combination of education and experience which would provide an equivalent background

• LI-SC1

Salary Band: 03B

This selected candidate will be expected to work hybrid in Indianapolis, IN but we may consider remote associates who are not local to Indianapolis, IN. 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.