LTD Claims Associate

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

The 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. To obtain and analyze information in order to make claim decisions and payments on disability claims. To develop and apply appropriate claim and disability management techniques to ensure prompt and accurate payment and liability management of disability claims. To provide responsive customer service to claimants, policyholders, brokers, and internal departments. Responsible for helping our 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.

We are currently seeking Level I, II & Sr Representative experience.

Primary duties may include, but are not limited to:

• LTD Claims Associate is responsible for the adjudication of more complex claims.  LTD Claim Associate is responsible for providing quality claim decisions, timely and accurate benefit payments in accordance with the policy/contract provisions, regulations and claim procedures for complex claims. Appropriately and independently use problem solving measures and discretion to investigate complex claims by utilizing investigative tools such as clinical and vocational team consults and referrals, independent peer reviews, medical examinations, motor vehicle reports, activity/investigations, surveillance, etc. Sr level Claims associates are involved in training and mentoring less experienced associates.
• Expected to conduct proactive, empathetic, knowledgeable, thoughtful communications with internal and external customers. Identifies, understands, and appropriately refers matters to legal counsel, accounting, or escalates claim issues with minimal leadership consultation. Actively delivers results by contributing to achieving and maintaining or exceeding departmental deadlines, requirements, service, accuracy, timeliness, and performance standards.
• The LTD Claims Associate will also be proficient at conducting 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: 50%
  • 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.
• Customer Experience and support 40%
  • 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.
• Appropriately and independently use critical thinking, problem solving measures and discretion to investigate complex claims by utilizing investigative tools such as independent peer reviews, medical examinations, autopsies, toxicology reports, activity/death investigations, surveillance, etc. 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. The Claims Associate Senior will be able to identify, understand, and appropriately refer 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.
• Process Improvement 10%
  • Demonstrate EWA and support of the OneAmerica Ways.
  • Identify opportunities for efficiency and innovation in process and communicate to leadership team.

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.
• Or any combination of education and experience which would provide an equivalent background

Salary Band: 04B (Senior); 03B (level II); 02B (level I)

#LI-SC1

This selected candidate will be expected to work hybrid in Indianapolis, IN or Portland, ME. We will consider remote work for candidates not local to these areas. The candidate will also be expected to physically return to the office in CA, IN or ME as business needs dictate or for team building and collaboration.

Consistent with applicable pay transparency laws, we disclose the compensation range for this position: $44,013 - $90,000 annually. Actual compensation will be determined by factors such as education, experience, geographical location, and other job-related factors permitted by law. In addition to base pay, this role is eligible for an annual incentive program.

We offer a comprehensive total rewards package designed to support you both at work and at home. Full‑time and part‑time associates working 30 or more hours per week are generally eligible for benefits, including but not limited to:

• 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* (*Indianapolis, Charlotte, Cincinnati)

If you are offered and accept this position, please be advised that OneAmerica Financial does not have any offices located in the State of New York and OneAmerica Financial associates are not permitted to work remotely in the State of New York.

Selected employees must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship. 

Disclaimer:  American United Life Insurance Company (“OneAmerica Financial”) is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee based on race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, gender identity), age, physical or mental disability, veteran or military status, genetic information, citizenship, or any other legally recognized protected basis under federal, state, or local 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 Financial, visit oneamerica.com/companies.