Claims Advocate II

AAA Life Insurance Company • Livonia, MI

1d • Hybrid

About The Position

The Claims Advocate II 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.

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.

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.
• Completion of AAA Life Insurance Company Product training within 6 months of accepting position.

Responsibilities

• Approve or deny claims within specified authority.
• Provides secondary signature for claims adjudicated by other team members within scope of authority.
• Resolves 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.

Benefits

• We are committed to ensuring equal employment opportunities for all job applicants and employees. Employment decisions are based upon job-related reasons regardless of an applicant's race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, marital status, genetic information, protected veteran status, or any other status protected by law.
• AAA Life Insurance Company does not offer immigration sponsorship for this position. This includes visa types such as H-1B, TN, and STEM OPT. Please do not apply if you currently require or may require employer-sponsored immigration support now or in the future.

What This Job Offers

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