Senior Long Term Disability 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 Long Term Disability Claims Specialist to join our Workforce Benefits Division. As a Senior Long Term Disability Claims Specialist, you will provide best practices and innovative solutions for end-to-end claims administration for our Long Term Disability product line.  Incumbents demonstrate an understanding of regulatory and compliance landscape related to supplemental health benefits and partners with Compliance, Legal and Support Services to resolve issues in a timely manner.

The ideal candidate combines strong technical expertise, regulatory knowledge, critical thinking, and compassion while helping customers navigate important life events.

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:

• College degree or equivalent experience preferred. 
• Minimum 5 years of experience handling Long Term Disability claims; experience with Short Term Disability  and/or absence management is a plus.
• Strong understanding of Long Term Disability claim adjudication and relevant federal/state regulations (e.g., FMLA, ERISA, HIPAA, ADA).
• Experience partnering with clinical/vocational professionals to support RTW efforts and complex decisioning.
• Effective verbal and written communication skills with the ability to explain complex decisions clearly and empathetically. 
• Demonstrated problem-solving and analytical skills with a customer-first mindset.
• Highly organized and detail-oriented with the ability to manage competing priorities.
• Proven ability to mentor peers and support a collaborative team environment.
• Proficiency with claims administration platforms and workflow/documentation tools. 
  

What makes you stand out:

• Experience with Short Term Disability and or absence management is a plus
• A strong service mindset, with a genuine commitment to supporting claimants and employer customers through what can be a difficult and uncertain time.
• The ability to balance technical expertise and sound claim decisions with empathy, responsiveness, and clear communication.
• Significant experience managing complex LTD claims from initial review through resolution.
• A reputation for being a trusted resource and collaborative partner who follows through and helps solve problems.
• Experience mentoring and developing others, while sharing knowledge and promoting consistency across the team.
• A continuous-improvement mindset, identifying opportunities to make processes more efficient while improving the customer and claimant experience.
• The ability to thrive in a growing organization where you can help shape how we work and the level of service we provide, not simply follow an established process.

#LI-KB1

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

You Can Be Who You Are

We 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.