Sr. Claims Support Analyst - Quality

Overview

AAA Life is a respected and trusted American brand that has been focusing on Life Insurance and Annuity Products since 1969. At AAA Life we have over 1.8 million policies where we take pride in earning the trust of our policyholders who understand our promise to be there for them – and their families – when we’re needed most. By joining the AAA Life team, you are joining a company that genuinely cares about helping each other, with a devotion to protect the lives of those around us. We embrace a diverse, equitable, inclusive culture where all associates can feel a sense of belonging and use their unique talents and perspective to influence, innovate, motivate, and thrive.

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.
Responsibilities
How You’ll Work
Work Solution: Remote
Relocation Eligibility: Not Available

- 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.

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