Hybrid STD Claims Examiner

OneAmerica Financial Partners, Inc; South Portland (ME); Hybrid; USD 74,485,000 - 123,987,000; Full time

Benefits offered by this job

Medical & prescription, dental, vision

Health Savings Account

Flexible Spending Accounts

Paid Time Off

Parental leave - 10 weeks

401(k) Plan

Pension Plan

Life & disability insurance

Wellness Program

Employee assistance program

Clinic access

Job summary

OneAmerica Financial Partners, Inc is seeking a STD Claims Examiner to adjudicate short-term disability claims and manage casework with client companies and the Claims department.

The role requires reviewing contracts, calculating benefits, and coordinating with LTD for smooth transitions, while maintaining confidentiality and regulatory compliance. Hybrid work options are available with some regional travel as needed.

Qualifications

• BA/BS or equivalent combination of education and experience.
• 5+ years of experience in managing Short Term Disability claims with first pay authority.
• Spanish language ability is a plus.
• Excellent math and calculation skills.
• Good decision making skills – able to analyze complex claim information.
• Working knowledge of Microsoft Excel and Word.

Responsibilities

• Promotes a positive customer service image through prompt, accurate and courteous responses to customer information needs.
• Consistently adheres to the documented workflow guidelines and established procedures.
• Maintains required levels of confidentiality.
• Demonstrates competency in all modules of training program and stays current with industry standards.
• Investigates and evaluates claims within departmental and regulatory guidelines.
• Interprets and administers contract provisions including eligibility, covered weekly earnings, total disability, offsets, and pre-existing investigations.
• Calculates benefits and processes financial activities including payments, stop payments, voids, reimbursements, and final benefits.
• Assists in subrogation process to recover money from third parties.
• Collaborates with LTD Examiner for transition and coordination of claims.
• Documents claim actions and communications.
• Refers activity outside authority for review.
• Communicates with claimants, policyholders and physicians to resolve issues.
• Manages expectations and obtains claim information efficiently.
• Investigates all relevant claim issues and issues payments/denials in compliance with procedures and regulations.
• Responds to customer service issues within required timeframes.
• Involves technical resources as needed and supports them to achieve outcomes.
• Meets or exceeds service, quality and production objectives.
• Identifies improvement opportunities with team and informs supervisor.

Skills

Spanish language skills

Math/calculation skills

Decision making

MS Excel

MS Word

Education

BA/BS or equivalent

Tools

Excel

Word

Job description

OneAmerica Financial Partners, Inc is seeking a STD Claims Examiner to adjudicate short-term disability claims and manage casework with client companies and the Claims department.

The role requires reviewing contracts, calculating benefits, and coordinating with LTD for smooth transitions, while maintaining confidentiality and regulatory compliance. Hybrid work options are available with some regional travel as needed.