Senior Claims Support Analyst – Quality

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Conduct quality audits for Life, Annuity, and A&H claims to ensure compliance with regulations and adherence to internal processes.

• Create and present reports to management.

• Provide developmental feedback and coaching to claims personnel.

• Examine regulatory updates, revise procedure documents, and communicate changes to staff.

• Revise quality audit procedures and maintain criteria for audit reviews.

• Determine sample sizes for process and telephone call audits.

• Suggest modifications to examiner approval authority for claim decision audits.

• Offer secondary signoff on claims within the authority scope after claim decision audits.

• Review monthly accounting reconciliation reports and collaborate with claims staff to implement corrections.

• Analyze quality outcomes, accounting reconciliation discrepancies, and call quality to create training materials.

• Supervise the claims department's service recovery, ensuring the examination and prompt resolution of service issues.

• Compile monthly results and communicate findings along with recommendations for continuous improvement to Claims Leadership.

• Address Service Recovery Tickets, Department of Insurance Complaints, and Better Business Bureau Complaints.

• Review incoming tasks in Ultera for Claims work queues and route them appropriately.

• Generate daily queue-status reports for management and staff.

• Develop, update, and maintain procedural documentation.

• Train claims personnel on process modifications.

• Act as the Claims Department liaison for Internal Audit activities.

• Assist with external audits conducted by reinsurers and state market conduct examinations.

• Serve as a subject matter expert for various claim types and administrative functions.

• Identify system enhancements to minimize manual processing.

• Participate in project teams.

• Perform additional duties as assigned.

⛳️ Requirements

• Bachelor’s Degree in a relevant field or equivalent professional experience.

• ALHC Designation is preferred.

• FLHC Designation must be obtained within 24 months of job acceptance.

• At least 5 years of experience in Life/Health Claims, Underwriting, or a related field.

• Minimum of 5 years of experience in a customer service role.

• Prior experience in the continuous improvement of a quality system is preferred.

• Previous experience as a successful Claims Examiner at AAA Life Insurance Company is preferred.

• Extensive knowledge of insurance contracts, reinsurance, MIB, medical impairments, financial documentation, and claims investigation tools.

• In-depth understanding of legal aspects and statutory guidelines, including fair claims practices, HIPAA, Privacy, and ACLI Guidelines.

• Proficient in internet-based applications and Microsoft Office Suite, particularly Word, Excel, and PowerPoint.

• Ability to perform basic mathematical calculations.

• Willingness to work hours dictated by business needs, including flexible scheduling, irregular hours, weekends, and holidays.

• Capacity to establish and maintain effective professional relationships.

• Ability to manage multiple simultaneous projects in a fast-paced environment while meeting deadlines.

• Strong organizational and project management skills.

• Ability to work independently as well as collaboratively in a team setting.

• FLHC Designation must be obtained within 24 months of job acceptance.

• AAA Life Insurance Company does not provide 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.