Claims Quality Audit Director jobs in Alfred, ME

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 Director will have overall responsibility and accountability for effectively and efficiently leveraging staffing and technology in delivering claims adjudication and claims service for group short-term disability (STD) claims with absence. This role contributes to the development of strategic goals and objectives, as well as the overall leadership of the team. This role also collaborates with other departments across the enterprise to drive operational excellence.

Primary Duties May Include, But Are Not Limited To

• Performance and Service expectations: 50%
• Contribute to the development of strategic goals and objectives as well as the overall leadership of the claims team.
• Oversee and ensure claims are adjudicated timely and accurately to assure compliance with internal practices and State and Federal regulatory requirements.
• Monitor performance metrics and results and works with the cross functional teams to address opportunities and drive improvements. Leverage analytics to develop and execute strategic operative plans.
• Operational Excellence/Continuous Improvement 25%
• Drive continuous improvements by collaborating with claims leaders and leadership team to identify areas of best practice execution, quality assurance, training and improvement opportunities.
• Promote a culture of high performance and continuous improvement that values learning and a commitment to quality.
• Associate Engagement and Development: 25%
• Performs interviewing, hiring, employee performance evaluations, coaching, motivating, training, development opportunities, and holding associates accountable for achieving expected performance.
• Mentor and develop team members using a supportive and collaborative approach. Identify outcomes, accountabilities, and priorities, and then monitor and evaluate results.
• Provides team leadership to professionally develop and motivate associates and allows them to assume additional responsibilities and growth opportunities within the organization. Celebrate success within the organization. Foster associate engagement.
• Contribute to our relationship strategy by using empathy in decision-making to put our customers, partners, and stakeholders first, and to create unique experiences based on mutual trust and human connection.
• Participate in customer and sales meetings as needed.

Job Requirements

Required Education and/or Certifications

• Four-year college degree or an equivalent combination of related work experience and education

Recommended Education and/or Certifications

• ICA (Insurance Claims Associate); HIA (Health Insurance Associate); LOMA, FLMI (Fellow Life Management Institute); CEBS (Certified Employee Benefit Specialist)

Required Work Experience

• 10 years proven leadership skills. Working knowledge of Microsoft Word and Outlook
• Or any combination of education and experience which would provide an equivalent background

Salary Band: 07B

This selected candidate will be expected to work hybrid in Portland, ME. 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.

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.

Disclaimer: OneAmerica Financial 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 Financial, visit oneamerica.com/companies.