Senior Claims Advocate

AAA Life Insurance Company•Livonia, MI

11d•Hybrid

About The Position

AAA Life is seeking a Senior Claims Advocate to analyze, evaluate, and make final decisions on claims processed within the department, including complex claim types. The role includes resolving member complaints and participating in procedure development. The Senior Claims Advocate evaluates claims individually to determine whether they should be approved or denied, considering medical and physical, occupational, financial, and prior-claim histories. They consult with claims consultants and management, reinsurers, the medical director, risk management, and legal in accordance with department guidelines. The position may handle referrals from other staff, provide secondary signatures within prescribed limits and authority, train less-experienced claims staff, represent the company in litigated claims, and assist with projects and other assigned duties. The position may require flex scheduling, irregular hours, weekends, and holidays based on business needs.

Requirements

Bachelor’s degree, medical certification, or equivalent work experience.
Obtain the FLHC designation within 24 months of starting the position.
Proficiency with internet-based applications and Microsoft Office, specifically Word and Excel.
Ability to perform basic mathematical calculations, including addition, subtraction, multiplication, division, and percentages.
Ability to work hours required by business needs, which may include flexible scheduling, irregular hours, weekends, and holidays.

Nice To Haves

A minimum of 7 years’ experience in Life/Health/Auto Insurance Claims is preferred.
Life insurance underwriting experience, including knowledge of medical conditions, impairments, and the financial and legal aspects of risk selection and assessment of life insurance applications, is preferred.
Significant knowledge and understanding of insurance contracts, reinsurance, MIB, medical impairments, financial documents, and tools used to investigate and resolve claims.
Significant knowledge of legal aspects and statutory guidelines, including Fair Claims Practices, HIPAA, Privacy, and ACLI guidelines.

Responsibilities

Analyze, evaluate, and make final decisions on claims processed within the department, including complex claims.
Evaluate individual claims to determine whether to approve or deny them, considering medical and physical, occupational, financial, and prior-claim histories.
Consult with claims consultants and management, reinsurers, the medical director, risk management, and legal according to department guidelines.
Resolve member complaints and participate in procedure development.
Take referral cases from other staff and provide secondary signatures on files within prescribed limits and authority.
Assist with the development and regular training of less-experienced claims staff.
Represent the company for litigated claims.
Assist with projects and other duties as assigned.