Senior Long Term Disability Claims Specialist
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Job Description
Senior Long Term Disability Claims Specialist managing complex claims for Pacific Life Insurance Company. Ensuring compliant decisions, return-to-work strategies, and empathetic claimant experiences.
Responsibilities:
- Manage a diverse and complex caseload of Long Term Disability claims from initial intake through resolution
- Make timely, fair, and accurate claim decisions using sound judgment and policy provisions
- Collaborate with clinical and vocational partners to develop return-to-work strategies and determine benefit eligibility and durations
- Serve as a subject matter expert on Long Term Disability claim practices
- Consult on best practices and contribute to internal procedures, workflows, and system requirements
- Apply disability contract provisions, exclusions, riders, waivers, and regulatory and statutory requirements
- Document decisions and interactions accurately and communicate with claimants, employers, and internal stakeholders
- Mentor and support onboarding of new team members
- Collaborate with Compliance, Legal, Intake/Admin, Clinical and Vocational Services, and other business units
- Identify process gaps and contribute to continuous improvement and enterprise initiatives
- Adapt to changing priorities, business needs, and regulatory requirements
- Maintain confidentiality, professionalism, and integrity in claim-related activities
- Perform other duties as assigned
Requirements:
- Bachelor’s degree or equivalent work experience preferred
- 5+ years of Long Term Disability claims experience required
- Experience managing complex and high-risk cases preferred
- Ability to independently manage a full caseload and make sound decisions with limited oversight
- Strong communication skills for engaging with claimants, employers, providers, and internal partners
- Customer-focused, proactive, solutions-oriented approach to problem solving
- Ability to handle sensitive and difficult conversations with empathy and professionalism
- Ability to interpret and apply policy provisions, contractual language, and regulatory requirements
- Advanced knowledge of ERISA and related federal and state regulatory requirements
- Ability to apply guidelines to complex claim scenarios and ensure consistent, compliant outcomes
- Ability to develop and maintain strong knowledge of Pacific Life’s Workforce Benefits platforms, claims administration systems, and workflow tools
- Detail-oriented with balanced, objective decision-making and a high degree of integrity and accountability
- Advanced analytical and critical thinking skills
- Ability to evaluate complex medical, vocational, and financial information
- Ability to work independently and serve as a resource and informal mentor
- Ability to contribute to process improvements and best practices
- Strong organizational and time management skills
- Ability to prioritize competing demands and adapt quickly in a fast-paced, changing environment
Benefits:
- Medical, Dental, Vision, and Wellbeing Reimbursement Account for employees and eligible dependents
- Paid Time Off
- Holiday Schedules
- Financial Planning Time Off
- Paid Parental Leave
- Adoption Assistance Program
- Competitive 401k savings plan with company match
- Additional 401k contribution regardless of participation
- Flexible benefits that can be tailored to individual needs
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