Senior Medical Claims Processor

Pacific Life; Nashville (TN); On-site; USD 69,000 - 85,000; Full time

Benefits offered by this job

Medical, dental, vision

Wellbeing reimbursement account

Paid time off

Parental leave & adoption assistance

401(k) with company match

Job summary

Pacific Life is seeking a Sr Long Term Disability Claims Specialist to advance claims processes and ensure compliant, empathetic customer experiences.

You will manage complex LTD caseloads, collaborate with clinical partners, and mentor team members while navigating ERISA and HIPAA regulations within a Workforce Benefits framework.

Qualifications

• ~ Bachelor’s degree or equivalent work experience preferred.
• ~5+ years of Long Term Disability claims experience required, including management of complex cases.
• ~ Strong communication skills with claimants, employers, providers, and internal partners.
• ~ Ability to interpret and apply policy provisions, contractual language, and regulatory requirements.

Responsibilities

• Manage a diverse caseload of LTD claims from intake to resolution with timely and accurate decisions.
• Collaborate with clinical and vocational partners to develop RTW strategies and determine eligibility.
• Serve as a subject matter expert on LTD claim practices and help refine internal procedures.
• Ensure documentation and communication with claimants, employers and stakeholders.

Skills

LTD claims experience

Communication skills

Customer-focused

Policy interpretation

Regulatory knowledge

Education

Bachelor’s degree or equivalent

Tools

Claims systems

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 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.
• 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 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 RangeThe 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.$69,390.00 - $84,810.00

#LI-KB1Base 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.$69,390.00 - $84,810.00 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 AreWe 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.