• Support Claims teams by resolving complex system and process issues • Identify root causes and deliver timely solutions that improve daily operations • Collaborate with the Help Desk, IT, and business partners to enhance workflows • Contribute to system improvements and support testing and training efforts • Drive greater efficiency, reduce disruptions, and empower users to work more effectively and independently • Serve as subject matter expert for the Claims Help Desk on complex claims systems, administration, and technical issues • Triage and resolve escalated issues using diagnostics and root cause analysis • Deliver timely, accurate resolutions and recommend appropriate workarounds when needed • Partner with Help Desk and IT teams to support issue resolution and system improvements • Develop and maintain training materials, job aids, and procedural documentation • Collaborate with Claims Training to create resources and deliver user training • Act as liaison between Claims and IT to clarify business needs, outcomes, and impacts • Manage intake, escalation, and documentation in alignment with established standards and SOPs • Analyze and prioritize defects, bugs, and enhancement requests requiring long-term fixes • Ensure escalated issues are well-scoped, documented, validated, and tracked • Support system testing, enhancements, and identify improvement opportunities • Coordinate operational readiness activities like communications and adoption tracking • Partner with stakeholders to support non-technical project work and improve workflows/system usability

• Investigating, evaluating, and processing insurance claims • Determining policy coverage for the claimed loss • Creating and issuing claims decisions to policyholder • May order medical records from providers • May communicate with clients and providers during treatment • Performs other duties and responsibilities as assigned

Role Description We’re actively seeking a talented Sr. Life Claims Specialist to join the Workforce Benefits Division team, this position will be remote. - Serve as a subject matter expert on Life claim practices, consulting on best practices and contributing to the design and refinement of internal procedures, workflows, and system requirements. - Mentor and support onboarding of new team members; share expertise and foster knowledge growth within the team. - Proactively identify process gaps or opportunities and contribute to continuous improvement efforts and enterprise initiatives. - Manage a caseload of Group Life insurance claims that will include life, accelerated benefit, accidental death and dismemberment, and life waiver of premium claims from initial review through resolution. - Apply policy provisions to evaluate eligibility, validate beneficiary information, and gather all required documentation. - Analyze claim documentation such as beneficiary designations, autopsy, accident reports, medical, financial, and any other documentation to assess claim impact. - Make timely and accurate decisions by using critical thinking, adherence to policy provisions and sound problem-solving skills. - Accurately document decisions, rationale, and customer interactions. - Communicate clearly and empathetically with claimants, beneficiaries, employers, and internal stakeholders. - Collaborate across business functions to ensure a seamless and compliant claims experience. - 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. Qualifications - Bachelor’s degree or equivalent work experience preferred. - 5–7+ years of Life Insurance claims experience required, including adjudication of complex claims such as contestability reviews, exclusions, beneficiary disputes. - Demonstrated expertise in investigating, evaluating, and adjudicating life insurance claims from initial notice through claims decision in accordance with policy provisions and company guidelines. - Proven ability to interpret policy language, contractual provisions, and beneficiary designations, ensuring accurate, consistent, and defensible claim outcomes. - Possesses a strong knowledge of group life insurance policies, as well as knowledge of relevant regulatory and statutory requirements such as FMLA, ERISA, and HIPAA. - Strong working knowledge of state insurance regulations, ERISA (as applicable), and claims compliance standards, with the ability to apply regulatory requirements to complex claim scenarios. - Demonstrated ability to manage a full caseload independently, effectively prioritizing competing demands while meeting service, quality, and turnaround expectations. - Advanced analytical and critical thinking skills, including the ability to evaluate medical records, cause of death, financial documentation, and legal instruments (e.g., trusts, assignments, probate). - Strong communication skills with the ability to effectively engage with beneficiaries, funeral homes, attorneys, medical providers, and internal partners, delivering clear, timely, and compassionate communication throughout the claims process. - Demonstrated commitment to a customer-centric claims philosophy, with a strong focus on empathy, care, and respect, recognizing the sensitive nature of life claims and the impact on beneficiaries and families. - Demonstrated ability to navigate grief and emotionally complex situations with sensitivity and care, adapting communication style to meet individuals where they are and ensuring beneficiaries feel supported, respected, and treated with dignity. - Highly organized and detail-oriented, ensuring accurate benefit calculations, thorough documentation, and complete claim file management in support of audit readiness and defensibility. - Demonstrates ownership of outcomes, with a focus on timely, accurate, and customer-centered claim resolutions that build trust and confidence. Requirements - Ability to work independently while also serving as a subject matter expert and resource for less experienced team members, providing guidance and informal mentorship. - Ability to manage multiple priorities and adapt quickly in a fast-paced, evolving environment while maintaining quality and consistency. - Experience with claims administration systems and workflow tools; ability to quickly develop and maintain strong knowledge of Pacific Life’s Workforce Benefits platforms and processes. Benefits - 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.

• Perform and deliver on routine and progressively more non-routine workers compensation and subrogation assignments independently in accordance with established procedures/guidelines. • Support workers compensation and subrogation liens being pursued by vendor. • Communicate with responsible parties, insured’s agents, vendors, and/or attorneys to obtain and/or provide a diverse range of needed information. • Evaluate subrogation potential and either triage to our internal team or submit claims to the appropriate vendor. • Support settlement negotiations for our vendor. • Escalate lien if settlements would reduce lien amount by more than 1/3. • Respond to requests, including but not limited to, pay histories, information updates, and other document requests from various parties. • Communicate with policy holders, vendors, attorneys, and agents on the status of pending subrogation matters, as required by statutes, regulations, and/or service standards. • Apply refund checks in claims systems and processes vendor expense payments within established authority. • Prepare for ASO checks to be sent employers with appropriate template letters. • Adhere to all applicable statutes and regulations as well as company protocols.