LTD Claims Examiner

OneAmerica; Portland, Northern (ME, KY); Hybrid; USD 29,000 - 46,000; Full time

Benefits offered by this job

Health insurance

401(k) Plan with company match

Paid Time Off

Parental leave (10 weeks)

Wellness Program

Job summary

OneAmerica Financial, headquartered in Indianapolis, IN, seeks a Level I LTD Claims Associate to support the claims team. The role focuses on reviewing claim files for overpayments, gathering missing information, and pursuing timely recovery while maintaining professional relationships with claimants.

Responsibilities include analyzing files, communicating with internal/external customers, and documenting actions in the claim system. Requires 1+ year of claim experience and relevant education.

Qualifications

• Associate/Bachelor’s degree in accounting/finance or equivalent preferred.
• Demonstrates computer literacy and working knowledge of claim systems.
• Strong written and verbal communication and interpersonal skills.

Responsibilities

• Analyze claim file content and obtain required info from colleagues, customers and external sources.
• Manage a caseload of overpayments with accuracy across multiple products and systems.
• Negotiate and bind the Company on overpayment recovery decisions.
• Document and code financial recovery actions with rationale and next steps.
• Provide excellent customer service, maintain professional relationships with claimants.

Skills

Communication skills

Team collaboration

Computer literacy

Time management

Self-motivated

Education

Associate/Bachelor’s degree in accounting/finance

Bachelor’s degree or equivalent work experience

Tools

FINEOS

Excel

PowerPoint

Tableau

Job description

RO Portland ME
South Portland, ME 04106, USA

Description

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

LTD Claims Associate is responsible to contribute to the overall success of OneAmerica's objectives by providing timely and accurate support to our customers and the claims department. The associate is responsible for reviewing the content of a claim file to determine if all pertinent information is available to perform a complete and accurate determination of the overpayment. Upon completion of the file review, the associate determines whether additional follow-up with both internal and external customers may be necessary to acquire missing documentation/information. Once a file is complete and an overpayment has been determined by the associate, the associate works directly with the claimant or advocate, primarily on the phone, to ensure that overpayments are recovered timely and in accordance with the specific policy language. This is a highly goal-oriented role; the associate is responsible for significantly contributing to the unit's overall recovery results. The associate's complexity of files increases as he/she attains a strong knowledge base which is necessary to effectively administer recovery of overpayments on multiple products and systems.

We are currently seeking Level I experience.

Primary duties may include, but are not limited to:

• Analyze content of claim file and obtaining the necessary financial and benefit information (that may not be immediately apparent) from colleagues, customers and external resources to determine appropriate course of action on each file.
• Consistently calculates, communicates and manages a caseload of claims with varying levels of complexity, demonstrating a strong technical ability necessary to administer overpayment claims across multiple products and system applications.
• Negotiates and binds the Company with respect to decisions made regarding appropriateness of pursuing overpayments.
• Thoroughly and accurately documents and codes financial recovery actions in claim system with supporting rationale for actions and next steps.
• Secures a professional relationship with the claimant, provides excellent customer service, demonstrates empathy and remains open to new information. Provides prompt, accurate, and courteous responses to customers to promote the OneAmerica brand.
• Participates in special projects and other assignments as needed.
• Customer Experience and support:
  • Effectively, accurately and timely communicates and collaborates with internal and external customers in accordance with departmental customer service protocols.
  • Demonstrates ability to accurately, collect and analyze overpayment information to determine applicable next steps resulting in recovery of outstanding overpayment in accordance with policy/contract provisions, regulations, and department procedures.
  • Appropriately learn and grow critical thinking skills, problem solving measures and discretion to obtain and/or clarify information with limited leadership oversight.
• Performance and Service expectations:
  • Actively delivers results and contributes to and maintains or exceeds departmental deadlines, requirements, service, accuracy, timeliness, and performance standards. The Overpayment/Financial Recovery Specialist I will take appropriate action to achieve objectives and will with limited leadership assistance adjust actions and assist fellow associates in response to shifting priorities and rapid change.
  • Demonstrates the flexibility to perform other duties and projects as assigned.
• Process Improvement:
  • 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

• Associate/Bachelor’s degree in accounting/finance or the equivalent preferred
• Demonstrates computer literacy and/or working knowledge of various claim systems (i.e. FINEOS, Excel, PowerPoint, Tableau)
• Solid oral and written communication and interpersonal skills
• Demonstrates efficiency in time management and ability to multi-task goals and priorities
• Ability to work with others in a highly collaborative team environment
• Self-motivated in a goal-oriented environment
• Adaptable to change
• Able to deal with conflict effectively and professionally
• Proven work ability in a fast-paced office environment preferred

Recommended Education and/or Certifications

• Bachelor’s degree or equivalent work experience
• Min of 1+ year prior claim experience preferably in: Group Benefits, Collections, General Liability, Product Liability, Workers Compensation subrogation and third-party reimbursement
• Demonstrated understanding of Short-Term Disability (STD) and/or Long-Term Disability (LTD) claim principles
• Self-motivated with the ability to prioritize competing requirements successfully
• Readily able to build successful business relationships with members of the office and field organization
• Effective organizational skills
• Consistent high level of performance and achievement over career span.

Required Work Experience

• Prior experience within a claim operation preferred. Minimum of 1+ years’ work experience required.
• Customer Service, and experience working with Microsoft applications.
• Good decision-making skills-able to analyze complex information.
• Strong verbal and written communications.
• High School Diploma required, or any combination of education and experience which would provide an equivalent background.

#LI-SC1

Salary Band: 02C

This selected candidate will be expected to work hybrid in Indianapolis, IN. Candidates based in the Portland, ME area may be eligible to work from home, subject to business needs and evolving workplace policies. 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 - $33.65 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.

We offer a comprehensive total rewards package designed to support you both at work and at home. Full‑time and part‑time associates working 30 or more hours per week are generally eligible for benefits, including but not limited to:

• Medical & prescription, dental, vision insurance
• Health Savings Account & Flexible Spending Accounts
• Paid Time Off
• 10 weeks 100% paid parental leave (after completing 12 months of employment)
• 401(k) Plan with company match
• Pension Plan
• Company paid life & disability insurance
• Wellness Program & Company paid employee assistance program
• Clinic access subject to location* (*Indianapolis, Charlotte, Cincinnati)

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.

Selected employees must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship.

Disclaimer: American United Life Insurance Company (“OneAmerica Financial”) is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee based on race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, gender identity), age, physical or mental disability, veteran or military status, genetic information, citizenship, or any other legally recognized protected basis under federal, state, or local 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.

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.