For nearly 160 years, we’ve delivered products and services that help protect the financial future of our customers.
Senior Long Term Disability Claims Specialist
Location
United States
Posted
4 days ago
Salary
$77.1K - $94.3K / year
Seniority
Senior
Job Description
Senior Long Term Disability Claims Specialist
Pacific Life
• 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.
Job Requirements
- 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.
Benefits
- 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.
- 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.
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