Clinical Care Consultant

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.

Job Summary

The Clinical Consultant is responsible for supporting OneAmerica’s Claims operation acting both in a consultative nature during claim discussions and to provide comprehensive reviews of medical information. They are responsible for discussing and documenting an assessment of a claimant's potential for recovery and work function. Clinical Consultants also work closely with claims associates to educate regarding medical conditions, treatment, & recovery to function.  

Primary duties may include, but are not limited to

• Current with medial technology, conditions, treatments and expected recovery and prognosis of medical conditions. Maintains expertise to educate others and suggest process change when updates occur in the medical industry.

• Conduct comprehensive clinical assessments of Short- and Long-Term Disability claims and Life Waiver of Premium.

• Participate in multidisciplinary meetings as the clinical resource. Provide answers regarding medical issues, and functionality. Provide clear and complete clinical short and long-term clinical recommendations.  
• Assist claims associates with preparing information needed for peer reviews, IMEs, or FCEs by providing guidance around the specialty of provider to utilize and questions to ask of that provider.
• Collaborate with internal resources to assist the claims team in developing a sound action plan for a claim.
• Provide support and training to the claims department around specific medical conditions and clinical trends to improve medical knowledge. 

• Document claim files and systems in a clear and professional manner. Communicate effectively and professionally with a wide variety of peers and resources.
• Ability to influence and teach others. Use facilitation skills in a variety of discussions.
• Work in a self-directed way being able to make independent judgments and decisions.
• Prioritize and organize work independently while keeping the team and broader organizational needs in mind.
• Strong research, analytical, critical thinking, problem solving skills and decision-making skills
• Thrives in a fast-paced, service-oriented work environment with the need to pivot priorities according to needs of the business.
• Computer skills with strong proficiency in Microsoft programs especially Word, Excel, Outlook email and Teams web-conferencing and messaging.

• Identify opportunities for process improvements.
• Participate in projects, as needed, within the department.
• Maintains a level of participation and commitment to OAs security, privacy and ethic policies.

Job Requirements

Required Education and/or Certifications

• Current & active Registered Nurse (RN) license in their state of residency required. BSN preferred.

Required Work Experience

• Clinical experience in acute care setting.
• 1-year clinical experience in claims organization preferred, but not required.

 Salary Band: 06B

#LI-SC1

This selected candidate will be expected to work Hybrid in Portland, ME. We may consider remote work for candidates not local to Portland, ME. The candidate will also be expected to physically return to the office in CA, WI, 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: $79,500 - $132.500 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.