Senior Claims Strategy & Appeals Leader

AAA Life Insurance Company; Livonia (MI); Hybrid; USD 150.000 - 230.000; Vollzeit

Zusammenfassung

AAA Life Insurance Company seeks a Senior Claims leader to steer complex, contestable, and litigation-related life insurance claims. You will guide policy interpretation, investigations, and regulatory compliance while driving modernization, analytics, and risk management in a hybrid work environment.

In this role you will mentor examiners, partner with Underwriting, Actuarial, Legal, and Risk teams, and translate trends into actionable strategies to protect policyholders and enhance outcomes.

Qualifikationen

• Bachelor's degree or higher in a relevant field.
• 10+ years of progressive life insurance claims experience with complex adjudication.
• 5+ years of direct experience adjudicating or overseeing complex contestable life insurance claims.
• 5+ years of leadership experience.
• Experience with appeals, complex coverage, litigation-related claims, investigations, and regulatory requirements.
• Experience educating or developing claims examiners.

Aufgaben

• Provide strategic and technical leadership for complex, contestable, appealed, escalated, and litigation-related life insurance claims.
• Serve as the senior claims SME, guiding policy interpretation, investigations, beneficiary issues, underwriting, medical evidence, fraud indicators, and regulatory requirements.
• Exercise independent judgment within delegated authority and elevate significant risks.
• Lead technical strategy for appeals, disputes, complaints, litigation, and other elevated claims with Legal, Compliance, and stakeholders.
• Develop examiner capabilities through education, coaching, mentoring, case consultation, and consistent claims standards.
• Analyze claims trends, appeals, litigation, complaints, and quality results to identify risks and improvement opportunities.
• Provide leadership insights on claims trends, technical risk, and strategic opportunities.
• Lead claims transformation and modernization efforts, including workflow redesign and AI-enabled capabilities.
• Partner across Underwriting, Actuarial, Legal, Compliance, Risk, Investigations, Technology, and Reinsurance to resolve complex matters and strengthen risk management.

Kenntnisse

Leadership

Claims adjudication

Regulatory compliance

Policy interpretation

Investigation

Data analytics

Litigation management

Mentoring/examiner coaching

Cross-functional collaboration

Ausbildung

Bachelor's degree in business, insurance, finance, legal studies, risk management, or related field

Advanced degree preferred (JD, MBA, or related)

Jobbeschreibung

AAA Life Insurance Company seeks a Senior Claims leader to steer complex, contestable, and litigation-related life insurance claims. You will guide policy interpretation, investigations, and regulatory compliance while driving modernization, analytics, and risk management in a hybrid work environment.

In this role you will mentor examiners, partner with Underwriting, Actuarial, Legal, and Risk teams, and translate trends into actionable strategies to protect policyholders and enhance outcomes.