Senior Claims Advocate

AAA Life Insurance Company; Livonia (MI); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Pension and Retirement Plans

Medical, Dental and Vision Coverage

Paid Time Off

Paid Parental Leave

Hybrid Work Environment

401K

Support for Community Involvement

Job summary

AAA Life Insurance Company seeks a Senior Claims Advocate to analyze and decide complex claims across life, health, and related products. You will work with claims consultants, reinsurers, medical directors, and risk management, evaluating medical histories, financial data, and prior claims to reach final determinations.

The role includes training less-experienced staff, handling litigated claims, and contributing to procedure development.

Qualifications

• Bachelor degree, medical certification, or equivalent work experience.
• FLHC Designation required within 24 months of starting position.
• Minimum 7 years’ experience in Life/Health/Auto Insurance Claims experience preferred.
• Knowledge of insurance contracts, reinsurance, MIB, medical impairments, financial documents.
• Proficient using internet based applications and Microsoft Office.
• Able to work hours as required by business needs (flex scheduling, irregular hours, weekends, holidays).

Responsibilities

• Analyze and determine final decision for all types of claims processed within the department.
• Resolve member complaints and assist with procedure development.
• Assist with development and training of less expert claims staff.
• Act as company representative for litigated claims and support related projects.

Skills

Insurance claims knowledge

Mathematical calculations

Microsoft Office (Word, Excel)

Flexibility with hours

Education

Bachelor degree or equivalent

FLHC designation within 24 months

Tools

MIB database

Claims investigation tools

Job description

Overview

AAA Life is seeking a Senior Claims Advocate! By joining AAA Life, you will have the opportunity to strengthen the name and reputation of the brand that millions have come to rely upon for financial piece of mind. We are a company dedicated to our members and our employees. We value the unique attributes and contributions of our associates to build an inclusive, collaborative and innovative workplace where all employees are engaged and feel they belong. Delivering our company’s promise to members is what drives each of our associates every day!

We offer a dynamic work environment, excellent benefits, and competitive compensation, that will allow you will exercise your potential to innovate, finding ways to increase efficiency and enhance our business processes.

Consistent with our service philosophy of speed, accuracy, and style, this individual analyzes, evaluates, and determines final decision for all types of claims processed within the department, including complex claim types. Member Complaint resolution and active involvement in procedure development are also required.

Responsibilities

This role will require responsibility for multiple types of complex claims which may include all types of Life Insurance, Contestable, Accidental Death, Accidental Injury, Accidental Dismemberment, and Rider Claims. The Senior Claims Advocate settles whether to approve or deny a claim based upon a thorough evaluation of each individual claim. These evaluations include, but are not limited to, in-depth medical and physical history, occupational history, financial background, and prior claim history. They will consult with claims consultant and management, reinsurers, medical director, risk management, legal, in accordance with department guidelines. They may take referral cases from others and provide secondary signature on files within prescribed limits and authority. This individual will assist with the development and training of less expert claims staff on a regular basis, and will act as a company representative for litigated claims and may also assist with projects and other duties as assigned.

Qualifications

• Bachelor degree, medical certification, or equivalent work experience.
• FLHC Designation required within 24 months of starting position.
• Minimum 7 years’ experience in Life/Health/Auto Insurance Claims experience preferred.
• Life insurance underwriting experience including knowledge and understanding of medical conditions, impairments and the financial and legal aspects of risk selection and other factors pertaining to acceptability and assessment of life insurance applications, preferred.
• Demonstrates significant knowledge and understanding of insurance contracts, reinsurance, MIB, medical impairments, financial documents, and tools used to investigate and resolve claims.
• Demonstrates significant knowledge regarding legal aspects and statutory guidelines including Fair Claims Practices, HIPAA, Privacy, and ACLI guidelines.
• Proficient using internet based applications and Microsoft office products, specifically Word and Excel.
• Able to perform basic mathematical calculations to include addition, subtraction, multiplication, division, and percentage.
• Able to work hours as required by business needs (may include flex scheduling, irregular hours, weekends, and holidays).

Benefits:

We offer a variety of social programs, flexible work hours and family-friendly benefits to all of our employees.

• Pension and Retirement Plans
• Medical, Dental and Vision Coverage
• Paid Time Off
• Paid Parental Leave
• Hybrid Work Environment
• 401K
• Support for Community Involvement

This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants as needed to enable them to fulfill these requirements.