Senior Supplemental Health Claims Specialist

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 Senior Supplemental Health Claims Specialist to join our Team in Newport Beach, CA; Omaha, NE or remote in Chattanooga, TN.

As a Senior Supplemental Health Claims Specialist you'll move Pacific Life and your career, forward by administering complex Supplemental Health and other voluntary benefits claims. You'll fill an existing role that sits on a team in the Workforce Benefits Division.

How you'll help move us forward:

• Serve as a subject matter expert across all aspects of supplemental health claims administration-consulting on best practices and recommending innovative, scalable solutions.

• Maintain organizational service standards across a caseload of varying size and complexity by using strategic, analytical, and empathetic approaches.

• Demonstrate deep knowledge of supplemental health policies, procedures, and contracts, including policy definitions, provisions, exclusions, riders, waivers, and applicable regulatory and statutory requirements.

• Build and refine claims workflows, procedures, and documentation in alignment with system capabilities, product features, and compliance expectations.

• Accurately adjudicate claims using sound judgment and comprehensive technical analysis, ensuring timely and fair liability determinations and benefit payments.

• Provide clear, well-documented rationales for claims decisions and communicate outcomes to internal and external stakeholders with clarity and professionalism.

• Develop and maintain a working knowledge of claims systems, and effectively leverage tools and data for adjudication, workflow management, and process improvements.

• Lead and/or participate in training and onboarding for new team members. Mentor peers and foster knowledge-sharing across the team.

• Collaborate with cross-functional teams, including Compliance, Legal, Intake/Admin, Clinical Services, and Billing to ensure seamless and compliant claims handling.

• Partner with specialized resources to support integrated and complex claim strategies.

• Support coordinated claim experiences across lines of business through well-communicated transition processes.

• Contribute to process improvement efforts and special projects by offering innovative ideas and a continuous improvement mindset.

• Actively participate in change management and enterprise initiatives, ensuring that updates to regulations or business priorities are reflected in daily operations.

• Stay current on industry trends and evolving regulations to maintain compliant and customer-focused claims practices.

• Demonstrate a high level of discretion when handling sensitive or confidential information.

The experience you bring:

• College degree or equivalent experience preferred

• 5+ years of Supplemental Health experience preferred

• Needs to be an effective communicator with externally facing presence.

• Customer-centric with problem-solving skillset

• Requires strong analytical skills

• Demonstrated time management and organizational skills

• Detail oriented with ability to make balanced and objective decisions with at the highest degree of integrity

• Ability to utilize logic and analytic discipline to solve problems and identify viable solutions

• Effective communication skills both verbal and written

• Demonstrated time management and organizational skills

• Ability to manage multiple priorities and approach work with an agile mindset

• Will need to gain expert knowledge of Pacific Life's workforce benefits platforms such as claims administration system and workflow tools

What makes you stand out:

• Growth mindset with a commitment to continuous learning and improvement.

• Strong time management and the ability to thrive in a fast-paced, evolving environment.

• Experience supporting cross-functional or enterprise initiatives and change management efforts.

#LI-KB1

You can be who you are.

People come first here. We're committed to an inclusive workforce. Learn more about how we create a welcoming work environment at www.pacificlife.com. What's life like at Pacific Life? Visit Instagram.com/lifeatpacificlife.

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 additional incentive pay.

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

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.