Long Term Disability (LTD) Claims Associate

About the role

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!

Primary Duties

• May Include, But Are Not Limited To:
  • Adjudicate more complex claims.
  • Provide quality claim decisions, timely and accurate benefit payments in accordance with the policy/contract provisions, regulations and claim procedures for complex claims.
  • Independently and effectively manage an assigned caseload of claims, in a fair and ethical manner.
  • Help customers maintain a sense of security and their well-being by independently and effectively managing an assigned caseload of claims, in a fair and ethical manner.
  • Conduct proactive, empathetic, knowledgeable, thoughtful communications with internal and external customers.
  • Identify, understand, and appropriately refer matters to legal counsel or escalate claim issues with minimal leadership consultation.
  • Deliver results by contributing to achieving and maintaining or exceeding departmental deadlines, requirements, service, accuracy, timeliness, and performance standards.
  • Conduct effective and relationship-building interviews that contain probing questions with all appropriate parties including claimant or their representative, policyholder, medical provider, attorneys, obtain and reveal all claim facts, the root of a claim issue/problem, or to resolve a customer issue.

Performance and Service Expectations

• Actively delivers results and contributes to and maintains or exceeds departmental deadlines, requirements, service, accuracy, timeliness, and performance standards.
• The LTD Claims Associate Senior will take appropriate action to achieve objectives and will independently adjust actions and assist fellow associates in response to shifting priorities and rapid change.
• Completes correct accounting transactions and clearing according to departmental procedures.
• Effectively, accurately and timely communicates and collaborates with internal and external customers in accordance with departmental customer service protocols.
• Demonstrates ability to independently investigate, collect, examine, claim or accounting information, to determine claim or accounting direction and make accurate, impartial, and quality claim determinations in accordance with claim facts, policy/contract provisions, regulations, and department procedures, for claims of complex nature.
• Correctly calculates and processes claim benefit payments due within authority level, in compliance with policy/contract provisions, regulations, and department procedures.
• Prepares quality communication to agents, policyowners, insureds, beneficiaries, policyholders, medical providers, or other customer and business relationship parties.
• Identifies, understands, and appropriately refers matters to legal counsel or escalates claim issues with minimal leadership consultation.
• Demonstrates the flexibility to perform other duties and projects as assigned, including but not limited to complex projects, authority and random quality audits of less experienced claim associates, etc.
• Actively leads by example when coaching, mentoring, and assisting less experienced associates.

Job Requirements

• Required Education and/or Certifications: High School Diploma or GED
• Recommended Education and/or Certifications: Bachelor's Degree preferred in Business Management, Operations Management, Statistics, or Insurance.
• LOMA, ICA Required
• Work Experience: 2+ years of LTD claims or related experience. Prior experience within a claim operation required. Minimum of 4 years' work experience required. Intermediate knowledge of long-term disability services and terminology. Demonstrated ability to manage multiple cases with accuracy and empathy. Customer Service, and experience working with Microsoft applications.

Benefits

• Comprehensive total rewards package including 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.