Pacific Life
Pacific Life
Pacific Life एक वित्तीय सेवाओं और बीमा कंपनी है, जो व्यक्तियों, परिवारों, व्यवसायों और संस्थानों को भविष्य की तैयारी में मदद करने पर केंद्रित है। इसकी पेशकशों में जीवन बीमा, वार्षिकी, सेवानिवृत्ति समाधान और कार्यबल लाभ शामिल हैं। 1868 में स्थापित यह कंपनी वित्तीय सुरक्षा के क्षेत्र में अपने लंबे अनुभव को ऐसे उत्पाद विकसित करने पर केंद्रित दृष्टिकोण के साथ जोड़ती है, जो अपने ग्राहकों के लिए दीर्घकालिक वित्तीय सुरक्षा और सार्थक परिणामों का समर्थन करते हैं।

Senior Supplemental Health Claims Specialist

Pacific Life seeks a senior claims specialist to administer complex supplemental health and voluntary benefits claims. The role includes adjudicating claims, refining workflows, and supporting compliant, customer-focused operations.

विवरण

  • Serve as a subject matter expert in supplemental health claims administration.
  • Maintain service standards across caseloads of varying size and complexity.
  • Apply knowledge of supplemental health policies, procedures, contracts, definitions, provisions, exclusions, riders, waivers, and regulatory requirements.
  • Develop and improve claims workflows, procedures, and documentation.
  • Adjudicate claims and make timely, fair liability determinations and benefit payments.
  • Record claims decisions and communicate outcomes to internal and external stakeholders.
  • Use claims systems, workflow tools, and data to adjudicate claims and improve processes.
  • Lead or support training and onboarding, mentor colleagues, and share knowledge.
  • Work with Compliance, Legal, Intake/Admin, Clinical Services, and Billing.
  • Coordinate with specialized resources on integrated and complex claim strategies.
  • Support consistent claims experiences across lines of business.
  • Contribute to process improvements and special projects.
  • Take part in change management and enterprise initiatives.
  • Track industry developments and regulatory changes.
  • Handle sensitive and confidential information with discretion.

आवश्यकताएँ

  • A college degree or equivalent experience is preferred.
  • Five or more years of supplemental health experience is preferred.
  • Communicate effectively and represent the organization in external interactions.
  • Bring a customer-focused approach and strong problem-solving skills.
  • Demonstrate strong analytical ability.
  • Manage time and organize work effectively.
  • Pay close attention to detail and make balanced, objective decisions with integrity.
  • Use logic and analytical discipline to solve problems and identify workable solutions.
  • Communicate clearly in writing and verbally.
  • Manage competing priorities and adapt to changing needs.
  • Develop expert knowledge of Pacific Life workforce benefits platforms, including claims administration systems and workflow tools.
  • Show commitment to continuous learning and improvement.
  • Have experience supporting cross-functional or enterprise initiatives and change management.

लाभ

  • Medical, dental, vision, and a wellbeing reimbursement account.
  • Paid time off.
  • Holiday schedules.
  • Financial planning time off.
  • Paid parental leave.
  • Adoption assistance program.
  • Competitive 401(k) savings plan with company match.
  • Additional 401(k) contribution regardless of participation.
  • Flexible benefits tailored to employee needs.

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