Senior Long Term Disability Claims Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee a varied and frequently intricate caseload of Long-Term Disability (LTD) claims from the initial intake phase through to resolution, ensuring decisions are timely, equitable, and precise by exercising sound judgment and adhering to policy provisions.

• Collaborate with clinical and vocational partners to devise effective Return-to-Work (RTW) strategies and assess appropriate benefit eligibility and durations.

• Act as a subject matter authority on LTD claims practices, offering consultation on best practices and aiding in the design and enhancement of internal procedures, workflows, and system requirements.

• Utilize a comprehensive understanding of disability contract provisions, exclusions, riders, waivers, and relevant regulatory and statutory mandates (such as FMLA, ERISA, HIPAA).

• Ensure meticulous and accurate documentation of all decisions and interactions, while communicating effectively with claimants, employers, and internal stakeholders.

• Mentor and assist in the onboarding of new team members; share knowledge and promote learning growth within the team.

• Collaborate across departments with Compliance, Legal, Intake/Admin, Clinical and Vocational Services, and other business units to provide a coordinated and compliant claims experience.

• Actively identify process gaps or opportunities and contribute to continuous improvement initiatives and enterprise objectives.

• Exhibit adaptability in responding to fluctuating priorities, business necessities, and regulatory requirements.

• Uphold a high standard of confidentiality, professionalism, and integrity in all activities related to claims.

⛳️ Requirements

• Bachelor’s degree or equivalent experience is preferred.

• A minimum of 5 years of Long-Term Disability claims experience is required, with a preference for managing complex and high-risk cases.

• Proven ability to independently handle a full caseload and make informed decisions with minimal oversight.

• Excellent communication skills, with the capability to effectively engage with claimants, employers, providers, and internal partners.

• Customer-centric with a proactive, solution-oriented approach to problem-solving.

• Established ability to manage sensitive and challenging conversations with empathy and professionalism.

• Competence in interpreting and applying policy provisions, contractual language, and regulatory requirements accurately and consistently.

• Advanced knowledge of ERISA and associated federal and state regulatory requirements, with a proven ability to apply guidelines to complex claim situations and ensure consistent, compliant outcomes.

• Will develop and sustain a strong understanding of Pacific Life’s Workforce Benefits platforms, including claims administration systems and workflow tools.

🏝️ Benefits

• Your wellbeing is a priority at Pacific Life, and we are dedicated to providing flexible benefits that can be customized to suit your needs.

• Emphasis on your health and wellbeing, including Medical, Dental, Vision, and a Wellbeing Reimbursement Account that can be utilized for yourself or 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 matching and an additional contribution regardless of participation.