STD Claims Examiner

Disclaimer: OneAmerica Financial•South Portland, ME

10d•Hybrid

About The Position

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. Job Summary The STD Claims Examiner is responsible for contributing 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. We are currently seeking Level I & II Representative experience.

Requirements

BA/BS or equivalent combination of education and experience
0-2+ years of experience in managing Short Term Disability claims with first pay authority
Excellent customer service skills
Excellent math and calculation skills
Good decision-making skills
Ability to analyze complex claim information
Working knowledge of Microsoft Excel and Word
High School Diploma required, or any combination of education and experience which would provide an equivalent background.

Nice To Haves

Ability to fluently speak and write Spanish a plus

Responsibilities

Promote a positive customer service image through prompt, accurate and courteous responses to customer information needs
Consistently adhere to the documented workflow guidelines and established procedures.
Maintain required levels of confidentiality
Demonstrate competency in all modules of training program.
Remain abreast of industry standards via internal/external continuing education
Promptly and thoroughly investigate and evaluate claims within departmental and regulatory guidelines
Interpret and administer contract provisions including, but not limited to, eligibility, covered weekly earnings, definition of Total Disability, verification of applicable offsets and pre-existing investigations
Calculate benefit and identify 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
Assist in the subrogation process to recover money from third parties
Work in coordination with an LTD Examiner to ensure an appropriate transition from the STD claim to LTD
Document claim file actions and telephone conversations appropriately
Refer claim activity outside authority level to Supervisor/Manager for review
Proactively communicate with claimants, policyholders and physicians to resolve investigations issues
Establish, communicate and manage claimant and policyholder expectations
Utilize 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
Respond to customer service issues within required timeframes
Involve technical resources (Social Security Specialist, medical resources and vocational resources) at appropriate claim junctures
Support relationships with technical resources to achieve appropriate outcomes
Meet or exceed departmental service, quality and production objectives
Collaborate 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