Senior Long-Term Disability Claims Leader

Pacific Life Insurance Company; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

Pacific Life Insurance Company seeks a Senior Long Term Disability Claims Specialist to manage end-to-end LTD claims, ensuring fair decisions while navigating FMLA, ERISA, and HIPAA requirements. You will mentor teammates and partner with clinical/vocational teams to support RTW efforts.

The role emphasizes analysis, documentation, and collaboration across Compliance, Legal, and Operations to deliver a compliant claims experience in a fast-changing environment.

Qualifications

• Minimum 5 years of experience handling Long Term Disability claims.
• Strong understanding of LTD adjudication and applicable federal/state regulations.
• Experience partnering with clinical and vocational professionals to support RTW efforts.
• Excellent verbal and written communication with a customer-first mindset.
• Proven problem-solving and analytical abilities with attention to detail.
• Highly organized and able to manage competing priorities.

Responsibilities

• 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.
• Perform other duties as assigned.

Skills

Long Term Disability experience

Regulatory knowledge (FMLA/ERISA/HIPAA

Clinical/vocational collaboration

Verbal and written communication

Problem-solving

Organizational skills

Claims systems proficiency

Education

College degree or equivalent experience

Tools

Claims administration platforms

Job description

Pacific Life Insurance Company seeks a Senior Long Term Disability Claims Specialist to manage end-to-end LTD claims, ensuring fair decisions while navigating FMLA, ERISA, and HIPAA requirements. You will mentor teammates and partner with clinical/vocational teams to support RTW efforts.

The role emphasizes analysis, documentation, and collaboration across Compliance, Legal, and Operations to deliver a compliant claims experience in a fast-changing environment.