LTD Claims Examiner

Preparing for the Future•South Portland, ME

4d•Hybrid

About The Position

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.

Requirements

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
Prior experience within a claim operation preferred.
Minimum of 1+ years’ work experience required.
Customer Service, and experience working with Microsoft applications.
Excellent in Math
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.

Nice To Haves

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.

Responsibilities

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.
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.
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.
Identify opportunities for efficiency and innovation in process and communicate to leadership team.