Eligibility and Member Services Specialist

Pacific Life; Omaha (NE); On-site; USD 3,611,000 - 4,429,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Wellbeing Reimbursement Account

Generous paid time off

Paid Parental Leave

Adoption Assistance Program

401k with company match

Job summary

Pacific Life in Omaha, Nebraska, is seeking an Eligibility & Member Services Specialist to join the Workforce Benefits Division. You will audit and resolve discrepancies in member data, collaborate with brokers and employers, and deliver a friction-free experience to our employer clients.

The role emphasizes data accuracy, end-to-end impact of policy and rate changes, and building trusted advisor relationships with Sales, Distribution, and Underwriting.

Qualifications

• College degree or equivalent experience preferred.
• 3-5 years of financial services, product compliance or group benefits operations experience
• Effective communicator with externally facing presence
• Customer-centric with problem-solving skillset
• Detail-oriented
• Strong analytical skills
• Demonstrated time management and organizational skills
• Intermediate skills with MS office applications

Responsibilities

• Research and remediate inforce client challenges related to member management.
• Identify root causes of complex member level discrepancies by researching plan design, rates, file feed data and comparing to Administration System and TPA information.
• Understand end to end impact of policy, rate, and member level changes to eligibility and billing.
• Identify needed changes to update member level data and coordinate file feeds for data accuracy.
• Leverage data from multiple sources and use tools and formulas for large comparisons.
• Determine back charges or credits that need reviewed and discuss with Underwriting, Billing and Distribution.
• Consult with clients and make decisions aligned with our operating model to resolve issues.
• Build strong relationships with Sales/Distribution, Brokers and Employers as a trusted advisor.
• Coordinate, manage and lead conversations with Employers, Brokers and other partners for exceptional customer experience.
• Own issues to ensure timely resolution and escalate to management with recommendations.
• Follow-up and provide transparent communications on status of outstanding issues.
• Understand the full Broker, Employer, and Employee journey to deliver elevated service.
• Work within departmental controls with a high standard of ethics.
• Know product offering, systems, and processes and data flows across journeys.
• Participate in team meetings and bring innovative ideas for continuous improvement

Skills

Effective communicator

Customer-centric

Detail oriented

Analytical skills

Time management

MS Office

Education

Bachelor's degree preferred

Tools

EIS System

Excel

MS Office

Job description

Job Description: Providing for loved ones, planning rewarding retirements, saving enough for whatever lies ahead – our policyholders count on us to be there when it matters most. It’s a big ask, but it’s one that we have the power to deliver when we work together. We collaborate and innovate – pushing one another to transform not just Pacific Life, but the entire industry for the better. Why? Because it’s the right thing to do. Pacific Life is more than a job, it’s a career with purpose. It’s a career where you have the support, balance, and resources to make a positive impact on the future – including your own.

We’re actively seeking a talented Eligibility & Member Services Specialist to join our Employer Services Team in Omaha, NE.

As an Eligibility and Member Services Specialist, you’ll move Pacific Life, and your career, forward by playing a key role in auditing and resolving discrepancies based on employer’s product configuration & the member level data received while delivering a first-class friction free experience to our employers in the Workforce Benefits Division. You will fill a new role that sits on a team of 15 people in the Workforce Benefits Division.

Your colleagues will include Eligibility, Account Executives and Billing professionals.

How you’ll help move us forward:

• Work independently with brokers and employers to research, problem-solve and remediate inforce client challenges related to member management.
• Identify root causes of complex member level discrepancies by researching plan design, rates, file feed data, kick outs and doing comparisons to Administration System and TPA information often arising during billing, renewals, amendments, and open enrollments.
• Understand end to end impact of policy, rate, & member level changes to eligibility and billing/premium with the ability to build a resolution plan to remediate.
• Identify needed changes to update member level data and coordinate along with file feeds to ensure system data is accurate.
• Leverage data from multiple sources and use tools and formulas to expediate large comparisons.
• Determine any back charges or credits that need reviewed for accuracy and can work with Underwriting, Billing and Distribution to discuss any needed negotiations on due amounts.
• Consult with clients and make decisions aligned with our organization operating model to ensure issues and/or requests are fully resolved.
• Build strong relationships with Sales/Distribution, Brokers and Employers as a trusted advisor within our Workforce Benefits Division.
• Coordinate, manage and lead conversations with Employers, Brokers and other partners to provide exceptional customer experience.
• Own issues to ensure timely resolution and escalates to management with recommendations on how to address unresolved service issues.
• Follow-up and provide transparent communications on the status of outstanding issues as needed.
• Understand the full Broker, Employer, and Employee journey to deliver elevated service in issue resolution.
• Work within departmental controls for all aspects of the role with a high standard of ethics.
• Strong knowledge of our product offering, system(s), and processes as well as understand how data flows throughout employer and employee journeys.
• Participate and contribute to team meetings or special tasks and assignments and brings innovative ideas and a continuous improvement mindset to the department.

The experience you bring:

• College degree or equivalent experience preferred.
• 3-5 years of financial services, product compliance or group benefits operations experience
• Needs to be an effective communicator with externally facing presence.
• Customer-centric with problem-solving skillset
• Detail-oriented
• Strong analytical skills
• Demonstrated time management and organizational skills
• Intermediate skills with MS office applications

What makes you stand out:

• Experience in Eligibility and Evidence of Insurability at a group carrier
• Prior work in EIS System
• Expert level experience in Excel

Base Pay Range:

The base pay range noted represents the company’s good faith minimum and maximum range for this role at the time of posting. The actual compensation offered to a candidate will be dependent upon several factors, including but not limited to experience, qualifications and geographic location. Also, most employees are eligible for additional incentive pay. $26.31 - $32.15

Your Benefits Start Day 1

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. Whether you are focusing on your physical, financial, emotional, or social wellbeing, we’ve got you covered.

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.

You Can Be Who You Are

We are committed to a culture of diversity and inclusion that embraces the authenticity of all employees, partners and communities. We support all employees to thrive and achieve their fullest potential.

What’s life like at Pacific Life?

Visit Instagram.com/lifeatpacificlife

EEO Statement:

Pacific Life Insurance Company is an Equal Opportunity /Affirmative Action Employer, M/F/D/V. If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at Pacific Life Insurance Company.

Pacific Life is more than a job — it’s a career with purpose. For nearly 160 years, we’ve helped people protect their financial futures through strength, stability, and innovation. Join us to make a meaningful impact and build a career where you can thrive. Learn more. Pacific Life's success is driven by our people. We create, embrace and sustain an inclusive workplace where all employees are respected and supported throughout their career. Our values inspire and direct our actions shaping the vibrant culture we proudly uphold. Learn more.