Sr. Claims Support Analyst - Quality

AAA Life Insurance Company • Livonia, MI

5d • Remote

About The Position

Operating within the core values and operating principles of the organization, supports the operations of the Claims Department. The Senior Claims Support Analyst conducts various quality audits of all claim types, including complex claims, administrative functions, and phone calls to ensure that we are meeting our regulatory obligations and adhering to departmental procedures. Oversees the Claims quality program through developing and maintaining the process review criteria, establishing sample size and recommending approval authority changes to management, training the Claims Support Analyst on call monitoring and claim auditing techniques, identifies, trends, communicates and coaches claims staff on key quality development opportunities.

Requirements

• Bachelor’s Degree in relevant field or equivalent work experience
• Minimum 5 years’ experience in Life/Health Claims, Underwriting, or other related field
• Minimum 5 years’ experience in a customer service field
• Proficient using internet based applications and Microsoft office products, specifically Word, Excel, and Powerpoint.
• 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).
• Ability to establish and maintain effective professional relationships.
• Ability to perform and/or coordinate the completion of multiple simultaneous projects in a fast-paced environment while maintaining deadlines.
• Extremely well organized, project management orientation
• Self-motivated, ability to work in a team environment and autonomously
• 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

• Prior experience in continual improvement of a quality system, preferred
• ALHC Designation
• FLHC Designation within 24 months of job acceptance
• Prior Experience as a successful Claims Examiner at AAA Life Insurance Company, preferred
• Demonstrates significant knowledge and understanding of insurance contracts, reinsurance, MIB, medical impairments, financial documents, and tools used to investigate and resolve claims.
• Demonstrates significant knowledge regarding legal aspects and statutory guidelines including fair claims practices, HIPAA, Privacy and ACLI Guidelines.

Responsibilities

• Performs quality audits for all types of claims including Life, Annuity, and A&H to ensure regulatory compliance and adherence to our internal processes and procedures.
• Develops and provides reports to management. Delivers developmental feedback and coaching to claims staff as needed.
• Reviews regulatory changes from compliance, updates procedure documents and communicates changes to staff. Updates quality audit process to ensure compliance.
• Develops and maintains audit review criteria. Establishes sample size for process and telephone call audits.
• Recommends changes in examiner approval authority for claim decision audits.
• Provides secondary signoff on claims within scope of authority following completion of all claim decision audits (payments and denials).
• Reviews monthly accounting reconciliation reports and works with claims staff to make corrections.
• Analyzes all quality results, errors found on accounting recons, and call quality to prepare new training content that will maximize efficiencies and effectiveness of the department.
• Oversees the service recovery for the claims department to include the examination and resolution of service breakdowns in a timely manner. Tabulates monthly results and reports findings to Claims Leadership including recommendations for continuous improvement activities that will improve department performance.
• Responds to Service Recovery Tickets including Department of Insurance Complaints and Better Business Bureau Complaints by providing oral or written responses.
• Assists with workflow management by quickly reviewing incoming work in Ultera for all Claims work queues and routes the work to the appropriate person/queue with the appropriate route instructions. Compiles daily report of queue status to management and staff to ensure that we are meeting service levels.
• Develops procedure documentation for new processes; Updates and maintains procedure documentation for existing processes. Communicates process changes to staff and works with Claims Support Analyst to train claims staff on process changes.
• Serves as the Claims Department liaison related to Internal Audit activities, to include presentation of process and procedure documents, department process audit results and requests for transaction or recorded call lists for the purpose of audit sampling. May also assist with external audits from reinsurers and state market conduct exams.
• Acts as a subject matter expert and provides technical expertise for all claim types and all administrative functions to aid in the development and training of claims staff to improve quality, judgement skills, decision making abilities, and productivity based on audit results.
• Identifies system enhancement needs to reduce manual processing.
• Participates on project teams and works effectively with departments involved.
• Performs other duties as assigned.

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: Senior