Claims Examiner jobs in Detroit, MI

Overview

Bring your claims experience to the next level! AAA Life Insurance is hiring for a Claims Examiner II to join our growing claims team!

This role analyzes, evaluates, and determines final decision for life, accidental injury & death, simple annuity and rider claims within scope of authority and experience level in accordance with established departmental and statutory guidelines. 

This position can be hybrid in our Livonia, MI office, our remote.

Responsibilities

• Review and assess newly reported life, accidental injury & death, simple annuity claims. May also review and assess specified Rider Claims, including Disability Waiver of Premium and Accelerated Death Benefit claims. May handle claims occurring outside of the US.
• Analyzes requirements to determine accurate claim decision based upon specific contract for life, accidental injury & death, simple annuity and rider claims within prescribed limits and authority. Refers cases outside of prescribed limits and authority to Senior Claims Examiner or Claims Consultant.
• Calculates benefits, including statutory interest, for life, accidental injury & death, simple annuity and rider claims.
• Responds to customer inquiries regarding claim matters and written correspondence via telephone, written letter, and e-mail.
• May conduct interviews with claimants, beneficiaries, or next of kin on any type of claim to gather information to adjudicate claim.
• Acts as a mentor and provides secondary signature on claims referred to them by Claim Examiner I team members that are within scope of authority.
• Prepares beneficiary correspondence to communicate adverse decisions when appropriate consistent with department guidelines and statutory requirements.
• Read and interpret complex insurance policies/provisions as they relate to the claim presented.
• Reads and interprets Reinsurance Treaties related to claim processing. Refers files to reinsurance in accordance with treaty requirements.

Qualifications

• Associate Degree, medical certification, or equivalent related work experience required.
• LOMA281 and LOMA2911) required within 12 months of starting position.
• ALHC Designation required within 24 months of starting position.
• Minimum 3 years’ experience in Life/Health Insurance or Claims processing experience or related field required.
• Life insurance underwriting experience including knowledge and understanding of medical conditions, impairments and the financial and legal aspects of risk selection and other factors pertaining to acceptability and assessment of life insurance applications, preferred.
• Demonstrates strong knowledge and understanding of Life, Accident, Annuity, and Heath Products Completion of AAA Life Insurance Company Product training within 6 months of accepting position.
• Demonstrates knowledge of HIPAA, Privacy, ACLI Guidelines, Unfair Claims Settlement Act/Laws, Life Insurance and Medical Terminology.
• Proficient using internet based applications and Microsoft office products, specifically Word and Excel.
• 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).

  What We Offer:

  • A collaborative, energetic work environment where you can put your passion for people to work
  • Medical, Dental, Vision, Life and Disability coverage available day one
  • Pension Plan
  • Performance-based incentive plan
  • 401k available with a Company match
  • Holidays and Paid Time Off
  • AAA Basic Membership