Senior Life Claims Specialist

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.

• Demonstrate 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.

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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 sit