Senior Claims Advocate

AAA Life Insurance Company•Livonia, MI

9d•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 claims. The role also handles member complaint resolution and participates in developing procedures. The position supports AAA Life’s commitment to delivering its promise to members with speed, accuracy, and style. The Senior Claims Advocate evaluates individual claims using relevant medical and physical, occupational, financial, and prior-claims history. The role includes consulting with internal and external experts, handling referrals and secondary file signatures within prescribed authority, training less experienced claims staff, representing the company in litigated claims, and assisting with projects and other assigned duties. The position may require flexible scheduling, irregular hours, weekends, and holidays based on business needs.

Requirements

Bachelor’s degree, medical certification, or equivalent work experience.
FLHC designation required within 24 months of starting the position.
Minimum 7 years of Life/Health/Auto Insurance claims experience preferred.
Significant knowledge 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.
Proficiency with internet-based applications and Microsoft Office products, 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, potentially including flexible scheduling, irregular hours, weekends, and holidays.

Nice To Haves

Life insurance underwriting experience, including knowledge of medical conditions, impairments, and the financial and legal aspects of risk selection and other factors affecting the acceptability and assessment of life insurance applications.

Responsibilities

Analyze, evaluate, and make final decisions on claims, including complex claims.
Handle claims involving life insurance, contestable claims, accidental death, accidental injury, accidental dismemberment, and rider claims.
Determine whether to approve or deny claims after evaluating medical and physical history, occupational history, financial background, and prior claim history.
Consult with claims consultants and management, reinsurers, the medical director, risk management, and legal in accordance with department guidelines.
Handle referral cases and provide secondary signatures on files within prescribed limits and authority.
Assist with developing and training less experienced claims staff on a regular basis.
Act as a company representative for litigated claims.
Resolve member complaints, participate in procedure development, and assist with projects and other assigned duties.