Senior Life Claims Specialist

Benefits

Additional Information

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 Sr. Life Claims Specialist to join the Workforce Benefits Division team, this position will be remote. How you'll help move us forward: Serve as a subject matter expert on Life claim practices, consulting on best practices and contributing to the design and refinement of internal procedures, workflows, and system requirements. Mentor and support onboarding of new team members; share expertise and foster knowledge growth within the team. Proactively identify process gaps or opportunities and contribute to continuous improvement efforts and enterprise initiatives. Manage a caseload of Group Life insurance claims that will include life, accelerated benefit, accidental death and dismemberment, and life waiver of premium claims from initial review through resolution. Apply policy provisions to evaluate eligibility, validate beneficiary information, and gather all required documentation. Analyze claim documentation such as beneficiary designations, autopsy, accident reports, medical, financial, and any other documentation to assess claim impact. Make timely and accurate decisions by using critical thinking, adherence to policy provisions and sound problem solving skills. Accurately document decisions, rationale, and customer interactions. Communicate clearly and empathetically with claimants, beneficiaries, employers, and internal stakeholders. Collaborate across business functions to ensure a seamless and compliant claims experience. D emonstrate 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: Bachelor's degree or equivalent work experience preferred 5-7+ years of Life Insurance claims experience required, including adjudication of complex claims such as contestability reviews, exclusions, beneficiary disputes, Demonstrated expertise in investigating, evaluating, and adjudicating life insurance claims from initial notice through claims decision in accordance with policy provisions and company guidelines Proven ability to interpret policy language, contractual provisions, and beneficiary designations, ensuring accurate, consistent, and defensible claim outcomes Possesses a strong knowledge of group life insurance policies, as well as knowledge of relevant regulatory and statutory requirements such as FMLA, ERISA, and HIPAA. Strong working knowledge of state insurance regulations, ERISA (as applicable), and claims compliance standards, with the ability to apply regulatory requirements to complex claim scenarios Demonstrated ability to manage a full caseload independently, effectively prioritizing competing demands while meeting service, quality, and turnaround expectations Advanced analytical and critical thinking skills, including the ability to evaluate medical records, cause of death, financial documentation, and legal instruments (e.g., trusts, assignments, probate) Strong communication skills with the ability to effectively engage with beneficiaries, funeral homes, attorneys, medical providers, and internal partners, delivering clear, timely, and compassionate communication throughout the claims process Demonstrated commitment to a customer-centric claims philosophy, with a strong focus on empathy, care, and respect, recognizing the sensitive nature of life claims and the impact on beneficiaries and families Demonstrated ability to navigate grief and emotionally complex situations with sensitivity and care, adapting communication style to meet individuals where they are and ensuring beneficiaries feel supported, respected, and treated with dignity Highly organized and detail-oriented, ensuring accurate benefit calculations, thorough documentation, and complete claim file management in support of audit readiness and defensibility Demonstrates ownership of outcomes, with a focus on timely, accurate, and customer-centered claim resolutions that build trust and confidence What makes you stand out: Ability to work independently while also serving as a subject matter expert and resource for less experienced team members, providing guidance and informal mentorship Ability to manage multiple priorities and adapt quickly in a fast-paced, evolvi

Your Match

How well this role fits your profile.

Company Intel

What employees say

Worked at pacificlife? Share your experience