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Pacific Life
Pacific Life
1,001 – 5,000 Employees
H1B Visa SponsorFinanceInsuranceRetirement
Pacific Life is a financial services and insurance company focused on helping individuals, families, businesses, and institutions prepare for the future. Its offerings include life insurance, annuities, retirement solutions, and workforce benefits. Founded in 1868, the company combines long-standing experience in financial protection with a focus on developing products that support long-term financial security and meaningful outcomes for its customers.
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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.

USUnited StatesNENebraskaTNTennessee
$69,390 – $84,810 / year
HybridFull-timeSeniorEnglish RequiredClaims Specialist

Description

  • 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.

Requirements

  • 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.

Benefits

  • 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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