Senior LTD Claims Strategist for Complex Cases

Pacific Life; Newport Beach (CA); On-site; USD 69,000 - 85,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Paid time off

Parental Leave

401k with company match

Job summary

Pacific Life is seeking a seasoned Long Term Disability claims professional to manage complex caseloads from intake through resolution. You will collaborate with clinical and vocational partners to set RTW strategies and determine benefit eligibility while adhering to ERISA and related regulations.

The role requires at least 5 years of LTD claims experience, excellent communication skills, and the ability to interpret policy provisions and regulatory requirements with empathy and professionalism.

Qualifications

• Bachelor's degree or equivalent work experience preferred.
• 5+ years of Long Term Disability claims experience, 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.

Responsibilities

• Manage a diverse and often complex caseload of LTD claims from intake through resolution.
• Collaborate with clinical and vocational partners to develop effective RTW strategies and determine benefit eligibility and durations.
• Serve as SME on LTD claim practices and contribute to design and refinement of internal procedures and workflows.
• Leverage understanding of disability contract provisions, exclusions, riders, waivers, and regulatory requirements (e.g., FMLA, ERISA, HIPAA).
• Ensure detailed and accurate documentation of all decisions and interactions for claimants and employers.
• Mentor and support onboarding of new team members and share expertise.

Skills

LTD claims expertise

Caseload management

Communication skills

Regulatory knowledge

Education

Bachelor's degree

Job description

Pacific Life is seeking a seasoned Long Term Disability claims professional to manage complex caseloads from intake through resolution. You will collaborate with clinical and vocational partners to set RTW strategies and determine benefit eligibility while adhering to ERISA and related regulations.

The role requires at least 5 years of LTD claims experience, excellent communication skills, and the ability to interpret policy provisions and regulatory requirements with empathy and professionalism.