Senior Long Term Disability Claims Specialist

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

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 Senior Long Term Disability Claims Specialist to join our Workforce Benefits Division. As a Senior Long Term Disability Claims Specialist , you will provide best practices and innovative solutions for end-to-end claims administration for our Long Term Disability product line. Incumbents demonstrate an understanding of regulatory and compliance landscape related to supplemental health benefits and partners with Compliance, Legal and Support Services to resolve issues in a timely manner.

The ideal candidate combines strong technical expertise, regulatory knowledge, critical thinking, and compassion while helping customers navigate important life events.

How you'll help move us forward :

• 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.

The experience you bring:

• College degree or equivalent experience preferred.
• Minimum 5 years of experience handling Long Term Disability claims; experience with Short Term Disability and/or absence management is a plus.
• Strong understanding of Long Term Disability claim adjudication and relevant federal/state regulations (e.g., FMLA, ERISA, HIPAA, ADA).
• Experience partnering with clinical/vocational professionals to support RTW efforts and complex decisioning.
• Effective verbal and written communication skills with the ability to explain complex decisions clearly and empathetically.
• Demonstrated problem-solving and analytical skills with a customer-first mindset.
• Highly organized and detail-oriented with the ability to manage competing priorities.
• Proven ability to mentor peers and support a collaborative team environment.
• Proficiency with claims administration platforms and workflow/documentation tools.

What makes you stand out:

• Experience with Short Term Disability and or absence management is a plus
• A strong service mindset , with a genuine commitment to supporting claimants and employer customers through what can be a difficult and uncertain time.
• The ability to balance technical expertise and sound claim decisions with empathy, responsiveness, and clear communication .
• Significant experience managing complex LTD claims from initial review through resolution.
• A reputation for being a trusted resource and collaborative partner who follows through and helps solve problems.
• Experience mentoring and developing others , while sharing knowledge and promoting consistency across the team.
• A continuous-improvement mindset , identifying opportunities to make processes more efficient while improving the customer and claimant experience.
• The ability to thrive in a growing organization where you can help shape how we work and the level of service we provide , not simply follow an established process.

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 offer