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

RO Portland ME
South Portland, ME 04106, USA

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 STD Claims Examiner is responsible forcontributing 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.

KEY 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. Remains abreast of industry standards via internal/external continuing education.
• Promptly and thoroughly investigates and evaluates claims within departmental and regulatory guidelines.
• Interprets and administers contract provisions including, but not limited to, eligibility, covered weekly earnings, definition of Total Disability, verification of applicable offsets and pre-existing investigations.
• Calculates benefit and identifies 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 procedures.
• Assists in the subrogation process to recover money from third parties.
• Works in coordination with an LTD Examiner to ensure an appropriate transition from the STD claim to LTD.
• Documents claim file actions and telephone conversations appropriately.
• Refers claim activity outside authority level to Supervisor/Manager for review.
• Proactively communicates with claimants, policyholders and physicians to resolve investigations issues.
• Establishes, communicates and manages claimant and policyholder expectations.
• Utilizes most efficient means to obtain claim information.
• Fully investigates all relevant claim issues, provides payment or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulations.
• Responds to customer service issues within required timeframes.
• Involves technical resources (Social Security Specialist, medical resources and vocational resources) at appropriate claim junctures.
• Supports relationships with technical resources to achieve appropriate outcomes
• Meets or exceeds departmental service, quality and production objectives.

Collaborates with team members and management in identifying and implementing improvement opportunities. Informs Supervisor of any trends noted within specific client companies.

All other duties as assigned.

We are currently seeking Level I, Level II, or Sr Level experience.

REQUIREMENTS:

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

Salary Band: 04B

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: $25.96 – $43.27 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.