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OneAmerica Financial · 5 hours ago

Short Term Disability (STD) Claims Examiner

South Portland, ME

Full-time

Hybrid

New Grad, Entry, Mid Level

0+ years exp

OneAmerica Financial is dedicated to delivering on promises when customers need them most. The STD Claims Examiner is responsible for managing the adjudication of short-term disability claims, ensuring timely and accurate support to client companies and the Claims department while promoting a positive customer service experience.

BankingCrowdfundingEducationFinancial Services

H1B Sponsor Likely

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

Qualification

Short Term Disability claimsCustomer service skillsCalculation skillsMicrosoft ExcelMicrosoft WordSpanish language proficiencyAnalytical skillsDecision-making skills

Required

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

Preferred

Ability to fluently speak and write Spanish a plus

Company

OneAmerica Financial

Glassdoor3.6

OneAmerica Financial® is a national financial services organization helping people build greater certainty for better moments, every day.

Founded in 1877

Indianapolis, Indiana, USA

1001-5000 employees

http://oneamerica.com

H1B Sponsorship

OneAmerica Financial has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (7)

2022 (7)