[Hiring] Senior Supplemental Health Claims Specialist @Pacific Life

Role Description

We’re actively seeking a talented Senior Supplemental Health Claims Specialist to join our Team in Omaha, NE or remote in Tennessee. 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.

• 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.

Qualifications

• 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 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.
• 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.

Requirements

• 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.

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.