Long-Term Disability Claims Associate II

Oneamerica South Portland , ME 04106

Posted 2 months ago

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.

To contribute to the overall success of One America's objectives by providing timely and accurate support to our client companies and the Claims department. To obtain and analyze information in order to make claim decisions and payments on disability claims. To develop and apply appropriate claim and disability management techniques to ensure prompt and accurate payment and liability management of disability claims. To provide responsive customer service to claimants, policyholders, brokers, and internal departments.

KEY RESPONSIBILITIES:

  • Successful completion of the Employee Development Disability Policy Knowledge and Claim Adjudication course.

  • Promptly and thoroughly investigates claims within departmental and regulatory guidelines.

  • Interprets and administers contract provisions including, but not limited to, eligibility, covered monthly earnings, definition of Total Disability, verification of applicable offsets and pre-existing investigations.

  • Develops, implements and modifies disability management plan to establish strategy and manage outcome.

  • Documents claim file actions and telephone conversations appropriately.

  • Participates in departmental Focus Reviews.

  • Identifies and investigates change in Total Disability definition (any occ).

  • Refers claim activity outside authority level to Supervisor/Manager for review.

  • Pro-actively 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 to meet customer expectations.

  • Involves technical resources (Social Security Specialist, medical resources, vocational resources) at appropriate claim junctures.

  • Supports relationships with technical resources to achieve optimal financial outcomes.

  • Actively contributes to departmental service, quality and financial objectives.

  • Remains current with all corporate and disability management practices.

  • Collaborates with team members and management in identifying and implementing improvement opportunities.

  • All other duties as assigned by management.

REQUIREMENTS:

  • BA/BS or equivalent combination of education and experience preferred.

  • 3 or more years of experience with LTD disability claims ideal

  • Experience with computer applications Word, Excel strongly desired.

  • Strong decision-making and information analysis skills.

  • Ability to meet deadlines while balancing competing demands.

  • Good math and calculation skills.

To learn more about our products, services, and the companies of OneAmerica, visit oneamerica.com/companies.

Disclaimer: OneAmerica 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.


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Long-Term Disability Claims Associate II

Oneamerica