STD CLAIMS ASSOCIATE Position Available In Cumberland, Maine

Post

STD CLAIMS ASSOCIATE

Job Category:

Operations in Force

Requisition Number:

STDCL005852

Posting Details

Posted:

April 22, 2025
Full-Time
Hybrid
Locations
Showing 1 location
RO Portland ME
South Portland, ME 04106, USA Job Details
Description 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 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.

KEY 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

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
Ability to fluently speak and write Spanish a plus
Excellent customer service skills
Excellent math and calculation skills
Good decision making skills – able to analyze complex claim information
Working knowledge of

Microsoft Excel and Word Salary Band:

2B #LI-SC1 This selected candidate will be expected to work hybrid in Indianapolis, IN or Portland, ME. The candidate will also be expected to physically return to the office in IN or ME as business needs dictate or for team-building and collaboration. If you are offered and accept this position, please be advised that OneAmerica does not have any offices located in the State of New York and OneAmerica associates are not permitted to work remotely in the State of New York.

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.

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, 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.