Claims Advocate II

AAA Life Insurance Company • Livonia, MI

3d • Hybrid

About The Position

AAA Life is a respected and trusted American brand that has been focusing on Life Insurance and Annuity Products since 1969. At AAA Life we have over 1.8 million policies where we take pride in earning the trust of our policyholders who understand our promise to be there for them – and their families – when we’re needed most. By joining the AAA Life team, you are joining a company that genuinely cares about helping each other, with a devotion to protect the lives of those around us. We embrace a diverse, equitable, inclusive culture where all associates can feel a sense of belonging and use their unique talents and perspective to influence, innovate, motivate, and thrive. We are hiring a Claims Advocate II that analyzes, evaluates, and determines final decision for life, accidental injury & death, simple annuity and rider claims within scope of authority and experience level in accordance with established departmental and statutory guidelines. May consult with senior claims staff of management regarding claim situations that require assistance. Has authority to approve or deny claims within specified authority. Provides secondary signature for claims adjudicated by other team members within scope of authority. Has authority to resolve complaints and is actively involved in procedure development. Communicates with members, beneficiaries, and legal representatives to appropriately adjudicate a claim. Provides guidance and support regarding questions on claim files to less tenured team members. Senior Claims Examiner or Claims Consultant review cases outside of prescribed limits and authority. May also assist with projects and performs other duties as assigned.

Requirements

• Associate Degree, medical certification, or equivalent related work experience required.
• LOMA281 and LOMA2911) required within 12 months of starting position.
• ALHC Designation required within 24 months of starting position.
• Minimum 3 years’ experience in Life/Health Insurance or Claims processing experience or related field required.
• Demonstrates knowledge of HIPAA, Privacy, ACLI Guidelines, Unfair Claims Settlement Act/Laws, Life Insurance and Medical Terminology.
• 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).
• While performing the duties of this job, the employee is frequently required to stand, walk, sit, use hands to finger, handle, or feel, talk, hear and concentrate. Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus.
• 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 accommodation will be made for otherwise qualified applicants as needed to enable them to fulfill these requirements.

Nice To Haves

• 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 strong knowledge and understanding of Life, Accident, Annuity, and Heath Products
• Completion of AAA Life Insurance Company Product training within 6 months of accepting position.

Responsibilities

• Reviews and assesses newly reported life, accidental injury & death, simple annuity claims. May also review and assess specified Rider Claims, including Disability Waiver of Premium and Accelerated Death Benefit claims. May handle claims occurring outside of the US.
• Analyzes requirements to determine accurate claim decision based upon specific contract for life, accidental injury & death, simple annuity and rider claims within prescribed limits and authority. Refers cases outside of prescribed limits and authority to Senior Claims Examiner or Claims Consultant.
• Calculates benefits, including statutory interest, for life, accidental injury & death, simple annuity and rider claims.
• Responds to customer inquiries regarding claim matters and written correspondence via telephone, written letter, and e-mail.
• May conduct interviews with claimants, beneficiaries, or next of kin on any type of claim to gather information to adjudicate claim.
• Prepares beneficiary correspondence to communicate adverse decisions when appropriate consistent with department guidelines and statutory requirements.
• Reads and interprets Reinsurance Treaties related to claim processing. Refers files to reinsurance in accordance with treaty requirements.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree