Senior Long Term Disability Claims Specialist

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $77.1k - $94.3k / year

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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Pacific Life

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1868

💸 Finance

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

• Manage a diverse and often complex caseload of LTD claims from initial intake through resolution, ensuring timely, fair, and accurate decisions using sound judgment and adherence to policy provisions. • Collaborate with clinical and vocational partners to develop effective RTW strategies and determine appropriate benefit eligibility and durations. • Serve as a subject matter expert on LTD claim practices, consulting on best practices and contributing to the design and refinement of internal procedures, workflows, and system requirements. • Leverage a deep understanding of disability contract provisions, exclusions, riders, waivers, and applicable regulatory and statutory requirements (e.g., FMLA, ERISA, HIPAA). • Ensure detailed and accurate documentation of all decisions and interactions, and communicate clearly with claimants, employers, and internal stakeholders. • Mentor and support onboarding of new team members; share expertise and foster knowledge growth within the team. • Collaborate cross-functionally with Compliance, Legal, Intake/Admin, Clinical and Vocational Services, and other business units to deliver a coordinated and compliant claims experience. • Proactively identify process gaps or opportunities and contribute to continuous improvement efforts and enterprise initiatives. • Demonstrate agility in adapting to changing priorities, business needs, and regulatory requirements. • Maintain a high level of confidentiality, professionalism, and integrity in all claim-related activities.

🎯 Requirements

• Bachelor’s degree or equivalent work experience preferred. • 5+ years of Long Term Disability claims experience required, including management of complex and high-risk cases preferred. • Demonstrated ability to independently manage a full caseload and make sound decisions with limited oversight. • Strong communication skills with the ability to effectively engage with claimants, employers, providers, and internal partners. • Customer-focused with a proactive, solutions-oriented approach to problem solving. • Proven ability to handle sensitive and difficult conversations with empathy and professionalism. • Ability to interpret and apply policy provisions, contractual language, and regulatory requirements accurately and consistently. • Advanced knowledge of ERISA and related federal and state regulatory requirements, with demonstrated ability to apply guidelines to complex claim scenarios and ensure consistent, compliant outcomes. • Will develop and maintain strong knowledge of Pacific Life’s Workforce Benefits platforms, including claims administration systems and workflow tools.

🏖️ Benefits

• Your wellbeing is important to Pacific Life, and we’re committed to providing you with flexible benefits that you can tailor to meet your needs. • Prioritization of your health and well-being including Medical, Dental, Vision, and Wellbeing Reimbursement Account that can be used on yourself or your eligible dependents. • Generous paid time off options including: Paid Time Off, Holiday Schedules, and Financial Planning Time Off. • Paid Parental Leave as well as an Adoption Assistance Program. • Competitive 401k savings plan with company match and an additional contribution regardless of participation.