Senior Claims Support Analyst – Quality

Job not on LinkedIn

🔥 0 minutes ago

🚗 Michigan – Remote

🚗 Michigan – Remote

⏰ Full Time

🟠 Senior

📞 Support Engineer

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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AAA Life Insurance Company

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1969

⚕️ Healthcare Insurance

💸 Finance

🛡️ Insurance

Healthcare Insurance • Finance • Insurance

AAA Life Insurance Company is a provider of various life insurance products, including Term Life Insurance, Whole Life Insurance, Universal Life Insurance, and Accident Insurance. They also offer annuities and a range of resources to help customers understand their insurance needs. With a focus on customer support and education, AAA Life Insurance Company aims to simplify the process of obtaining life insurance and offer tailored solutions to protect the financial future of individuals and their families.

📋 Description

• Perform quality audits for Life, Annuity, and A&H claims to ensure regulatory compliance and adherence to internal processes • Develop and provide reports to management • Deliver developmental feedback and coaching to claims staff • Review regulatory changes, update procedure documents, and communicate changes to staff • Update quality audit processes and maintain audit review criteria • Establish sample sizes for process and telephone call audits • Recommend changes to examiner approval authority for claim decision audits • Provide secondary signoff on claims within scope of authority after claim decision audits • Review monthly accounting reconciliation reports and work with claims staff to make corrections • Analyze quality results, accounting reconciliation errors, and call quality to develop training content • Oversee claims department service recovery, including examination and timely resolution of service breakdowns • Tabulate monthly results and report findings and continuous improvement recommendations to Claims Leadership • Respond to Service Recovery Tickets, Department of Insurance Complaints, and Better Business Bureau Complaints • Review incoming work in Ultera for Claims work queues and route work appropriately • Compile daily queue-status reports for management and staff • Develop, update, and maintain procedure documentation • Train claims staff on process changes • Serve as Claims Department liaison for Internal Audit activities • Assist with external audits from reinsurers and state market conduct exams • Act as subject matter expert for claim types and administrative functions • Identify system enhancement needs to reduce manual processing • Participate on project teams • Perform other duties as assigned

🎯 Requirements

• Bachelor’s Degree in relevant field or equivalent work experience • ALHC Designation preferred • FLHC Designation within 24 months of job acceptance • Minimum 5 years’ experience in Life/Health Claims, Underwriting, or other related field • Minimum 5 years’ experience in a customer service field • Prior experience in continual improvement of a quality system preferred • Prior experience as a successful Claims Examiner at AAA Life Insurance Company preferred • Significant knowledge of insurance contracts, reinsurance, MIB, medical impairments, financial documents, and claims investigation tools • 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, specifically Word, Excel, and PowerPoint • Ability to perform basic mathematical calculations • Ability to work hours required by business needs, including flex scheduling, irregular hours, weekends, and holidays • Ability to establish and maintain effective professional relationships • Ability to coordinate multiple simultaneous projects in a fast-paced environment while maintaining deadlines • Strong organization and project-management orientation • Ability to work both autonomously and in a team environment • FLHC Designation must be obtained within 24 months of job acceptance • AAA Life Insurance Company does not offer immigration sponsorship; applicants must not require employer-sponsored immigration support now or in the future

🏖️ Benefits

• Remote work arrangement • Regular full-time employment • Equal employment opportunity and reasonable accommodation