Absence Management Claims Consultant

Job not on LinkedIn

🔥 3 minutes ago

🌾 Nebraska, Tennessee – Remote

🌾 Nebraska – Remote 🎸 Tennessee – Remote

💵 $98k - $119.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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Pacific Life

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1868

💸 Finance

🛡️ Insurance

Finance • Insurance • Retirement

Pacific Life is a financial services company that offers a wide range of retirement and life insurance solutions. It provides annuities, life insurance, and workforce benefits designed to help individuals and institutions secure their financial futures. With nearly 160 years of experience and a strong commitment to customer trust, Pacific Life focuses on delivering stability and protection for its clients' families, businesses, and future goals. The company is dedicated to creating meaningful future outcomes through corporate social responsibility and innovative products.

📋 Description

• Serve as a key business partner in designing, implementing, and enhancing Pacific Life’s Paid Family and Medical Leave capabilities • Define business requirements, user stories, workflows, business rules, and system functionality for PFML administration • Act as PFML claims subject matter expert throughout requirements gathering, solution design, testing, implementation, and production support • Design and build the end-to-end PFML claims experience • Develop claims procedures, workflows, job aids, training materials, and operational documentation • Participate in system configuration reviews, user acceptance testing, workflow validation, defect identification, and implementation of PFML products and enhancements • Monitor evolving state PFML legislation and translate regulatory requirements into operational processes and system functionality • Recommend solutions to improve customer experience, claims outcomes, operational efficiency, and automation • Partner with Legal, Compliance, Employer Services, Customer Service, Operations, Product, Technology, and external vendors • Administer and adjudicate PFML claims from intake through resolution • Interpret state-specific eligibility requirements, benefit calculations, waiting periods, leave durations, and documentation requirements • Communicate claim decisions, requirements, next steps, and benefit information to claimants, employers, brokers, and internal partners • Identify opportunities to improve customer experience, operational efficiency, quality, and compliance • Assist with onboarding, training, mentoring, and development of team members • Participate in audits, quality reviews, special projects, process reviews, and departmental initiatives • Support change management, innovation, and continuous improvement initiatives • Handle confidential and sensitive information with sound judgment and discretion

🎯 Requirements

• College degree or equivalent work experience preferred • 5+ years of experience in PFML, disability claims, leave management, absence management, insurance claims, or a related field • Strong knowledge of state PFML programs, leave laws, regulatory requirements, and employer-sponsored leave and disability products • Experience interpreting statutes, regulations, policy provisions, administrative guidelines, and complex business requirements • Ability to make fair, balanced, and objective decisions with integrity and professionalism • Strong analytical, investigative, problem-solving, and critical-thinking skills • Excellent verbal and written communication skills • Customer-focused with a compassionate and empathetic approach • Strong organizational and time-management skills • Ability to work independently and collaborate with cross-functional teams • Experience supporting process improvement, workflow design, procedure development, training, quality assurance, testing, or system implementation • Ability to learn and become proficient in claims administration systems, workflow tools, reporting platforms, and related technologies • Insurance designations, industry certifications, and experience with FMLA, ADA, Disability, or integrated absence management programs preferred

🏖️ Benefits

• Medical, Dental, Vision, and Wellbeing Reimbursement Account • Paid Time Off • Holiday Schedules • Financial Planning Time Off • Paid Parental Leave • Adoption Assistance Program • Competitive 401k savings plan with company match and an additional contribution regardless of participation • Flexible benefits tailored to physical, financial, emotional, and social wellbeing