Senior Long Term Disability Claims Specialist

pacificlife; États-Unis; À distance; USD 90 000 - 120 000; Plein temps

Résumé du poste

Pacific Life seeks a Senior Long Term Disability Claims Specialist for the Work Force Benefits Division. You will manage complex LTD claims, collaborate with clinical and vocational partners, and drive process improvements while ensuring compliant, empathetic claimant interactions.

You will mentor teammates, handle sensitive conversations, and interpret policy provisions and ERISA regulations to ensure accurate outcomes.

Qualifications

• Bachelor's degree or equivalent work experience required.
• 5+ years of Long Term Disability claims experience.
• Ability to independently manage a full caseload with limited oversight.
• Strong communication with claimants, employers, providers, and internal partners.
• Customer-focused with proactive, solutions-oriented problem solving.
• Demonstrated empathy and professionalism in sensitive conversations.
• Ability to interpret policy provisions, contractual language, and regulatory requirements.
• Advanced knowledge of ERISA and related federal/state requirements.
• Knowledge of Pacific Life's Workforce Benefits platforms and claims systems.

Responsabilités

• Manage a diverse and complex caseload of LTD claims through intake to resolution, ensuring timely and fair decisions.
• Collaborate with clinical and vocational partners to develop RTW strategies and determine eligibility and durations.
• Serve as a subject matter expert on LTD claim practices and help refine internal procedures and workflows.
• Ensure detailed documentation of decisions and communications with claimants, employers, and stakeholders.
• Mentor onboarding of new team members and share expertise within the team.
• Coordinate cross-functionally with Compliance, Legal, Intake/Admin, Clinical and Vocational Services.
• Identify process gaps and contribute to continuous improvement initiatives.
• Demonstrate adaptability to changing priorities and regulatory requirements.

Connaissances

Claims management

Communication

Empathy

Analytical thinking

Formation

Bachelor's degree or equivalent

Outils

ERISA knowledge

Claims systems

Workflow tools

Description du poste

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 Sr Long Term Disability Claims Specialist to join our growing Work Force Benefits Division. As a Senior Long Term Disability Claims Consultant you'll move Pacific Life and you career forward by developing and refining claims processes, ensuring compliance with evolving regulations, and helping deliver a best-in-class, empathetic claims experience.

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.
• 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.
• Perform other duties as assigned.

The experience you bring:

• 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 Workforce Benefits platforms, including claims administration systems and workflow tools

What makes you stand out:

• Detail-oriented with the ability to make balanced, objective decisions with a high degree of integrity and accountability
• Advanced analytical and critical thinking skills, including the ability to evaluate complex medical, vocational, and financial information
• Ability to work independently while also serving as a resource and informal mentor to less experienced team members
• Demonstrates ownership of outcomes and contributes to process improvements and best practices
• Highly organized with strong time management skills and the ability to prioritize competing demands
• Ability to manage multiple priorities and adapt quickly in a fast-paced, changing environment

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 additiona