Pacific Life · 9 hours ago
Senior Claims Specialist - Short Term Disability
United States
Full-time
Remote
Senior Level
$67K/yr - $82K/yr
5+ years expPacific Life is a company dedicated to providing for loved ones and planning rewarding retirements. They are seeking a Senior Claims Specialist - Short Term Disability to lead the adjudication of complex claims and ensure compliance with regulations while delivering an empathetic claims experience.
FinanceFinancial ServicesInsurance
Responsibilities
Manage a diverse and often complex caseload of STD (Short Term Disability) 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 STD 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
Qualification
Required
Minimum 5 years of experience handling Short Term Disability claims
Strong understanding of Short 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
Demonstrated ability to work independently and exercise sound judgment
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
Preferred
College degree or equivalent experience preferred
Experience with Long Term Disability and/or absence management
Benefits
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
Company
Pacific Life
Pacific Life Insurance is an insurance company that provides life insurance products, annuities, and mutual funds.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
$1.44B2025-09-03Debt Financing· $750M
2025-06-18Debt Financing· $688.57M
Leadership Team
Howard Hirakawa
Senior Vice President, Fund Advisor Operations
Joe Krum
Senior Vice President & Managing Director, Global Institutional Investment Group
Recent News
Private Capital Journal
2025-12-05
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