Absence Management Claims Consultant

This is a fully remote position, open to applicants in Nebraska, +1 more state.

📋 Description

• Act as a vital business partner in the design, implementation, and enhancement of Pacific Life’s Paid Family and Medical Leave (PFML) capabilities.

• Establish business requirements, user stories, workflows, business rules, and system functionalities for PFML administration.

• Serve as the subject matter expert for PFML claims throughout the phases of requirements gathering, solution design, testing, implementation, and production support.

• Create and develop the comprehensive PFML claims experience.

• Formulate claims procedures, workflows, job aids, training materials, and operational documentation.

• Engage in system configuration reviews, user acceptance testing, workflow validation, defect identification, and the rollout of PFML products and enhancements.

• Keep abreast of evolving state PFML legislation and convert regulatory requirements into operational processes and system functionalities.

• Propose solutions to enhance customer experience, claims outcomes, operational efficiency, and automation.

• Collaborate with Legal, Compliance, Employer Services, Customer Service, Operations, Product, Technology, and external vendors.

• Manage and adjudicate PFML claims from initial intake to resolution.

• Analyze state-specific eligibility requirements, benefit calculations, waiting periods, leave durations, and documentation needs.

• Provide claim decisions, requirements, next steps, and benefit information to claimants, employers, brokers, and internal partners.

• Spot opportunities to enhance customer experience, operational efficiency, quality, and compliance.

• Aid in the onboarding, training, mentoring, and development of team members.

• Partake in audits, quality reviews, special projects, process assessments, and departmental initiatives.

• Support change management, innovation, and continuous improvement initiatives.

• Manage confidential and sensitive information with appropriate judgment and discretion.

⛳️ Requirements

• A college degree or equivalent work experience is preferred.

• Over 5 years of experience in PFML, disability claims, leave management, absence management, insurance claims, or a related field.

• Profound knowledge of state PFML programs, leave laws, regulatory requirements, and employer-sponsored leave and disability products.

• Experience in interpreting statutes, regulations, policy provisions, administrative guidelines, and complex business requirements.

• Capability to make fair, balanced, and objective decisions with integrity and professionalism.

• Strong analytical, investigative, problem-solving, and critical-thinking abilities.

• Exceptional verbal and written communication skills.

• A customer-focused approach with compassion and empathy.

• Excellent organizational and time-management skills.

• Ability to work autonomously and collaborate with cross-functional teams.

• Experience in supporting process improvement, workflow design, procedure development, training, quality assurance, testing, or system implementation.

• Proficiency in claims administration systems, workflow tools, reporting platforms, and related technologies is desirable.

• Insurance designations, industry certifications, and familiarity with FMLA, ADA, Disability, or integrated absence management programs are preferred.

🏝️ Benefits

• Medical, Dental, Vision, and Wellbeing Reimbursement Account.

• Paid Time Off.

• Holiday Schedules.

• Financial Planning Time Off.

• Paid Parental Leave.

• Adoption Assistance Program.

• Competitive 401k savings plan with company match and an additional contribution regardless of participation.

• Flexible benefits tailored to physical, financial, emotional, and social wellbeing.