Life Claims Examiner

STD Claims ExaminerAt 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.Job SummaryThe 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 Representative experience.Key Responsibilities:Promote a positive customer service image through prompt, accurate and courteous responses to customer information needsConsistently adhere to the documented workflow guidelines and established procedures.Maintain required levels of confidentialityDemonstrate competency in all modules of training program. Remain abreast of industry standards via internal/external continuing educationPromptly and thoroughly investigate and evaluate claims within departmental and regulatory guidelinesInterpret and administer contract provisions including, but not limited to, eligibility, covered weekly earnings, definition of Total Disability, verification of applicable offsets and pre-existing investigationsCalculate 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 proceduresAssist in the subrogation process to recover money from third partiesWork in coordination with an LTD Examiner to ensure an appropriate transition from the STD claim to LTDDocument claim file actions and telephone conversations appropriatelyRefer claim activity outside authority level to Supervisor/Manager for reviewProactively communicate with claimants, policyholders and physicians to resolve investigations issuesEstablish, communicate and manage claimant and policyholder expectationsUtilize most efficient means to obtain claim informationFully investigates all relevant claim issues, provides payment or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulationsRespond to customer service issues within required timeframesInvolve technical resources (Social Security Specialist, medical resources and vocational resources) at appropriate claim juncturesSupport relationships with technical resources to achieve appropriate outcomesMeet or exceed departmental service, quality and production objectivesCollaborate with team members and management in identifying and implementing improvement opportunities. Informs Supervisor of any trends noted within specific client companiesAll other duties as assignedRequirements:BA/BS or equivalent combination of education and experience0-2+ years of experience in managing Short Term Disability claims with first pay authorityAbility to fluently speak and write Spanish a plusExcellent customer service skillsExcellent math and calculation skillsGood decision-making skillsAbility to analyze complex claim informationWorking knowledge of Microsoft Excel and WordHigh School Diploma required, or any combination of education and experience which would provide an equivalent background.Salary Band: 3CThis selected candidate will be expected to work hybrid in 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.Consistent with applicable pay transparency laws, we disclose the compensation range for this position: $21.16-$39.66 hourly. Actual compensation will be determined by factors such as education, experience, geographical location, and other job-related factors permitted by law. In addition to base pay, this role is eligible for an annual incentive program.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.Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.