Senior Claims Specialist – Short Term Disability
Pacific Life
full-time
Posted on:
Location Type: Remote
Location: Tennessee • United States
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Salary
💰 $66,960 - $81,840 per year
Job Level
About the role
- Manage a diverse and often complex caseload of STD (Short Term Disability) claims from initial intake through resolution, ensuring timely, fair, and accurate decisions using sound judgment and adherence to policy provisions.
- Collaborate with clinical and vocational partners to develop effective RTW strategies and determine appropriate benefit eligibility and durations.
- Serve as a subject matter expert on STD claim practices, consulting on best practices and contributing to the design and refinement of internal procedures, workflows, and system requirements.
- Leverage a deep understanding of disability contract provisions, exclusions, riders, waivers, and applicable regulatory and statutory requirements (e.g., FMLA, ERISA, HIPAA).
- Ensure detailed and accurate documentation of all decisions and interactions, and communicate clearly with claimants, employers, and internal stakeholders.
- Mentor and support onboarding of new team members; share expertise and foster knowledge growth within the team.
- Collaborate cross-functionally with Compliance, Legal, Intake/Admin, Clinical and Vocational Services, and other business units to deliver a coordinated and compliant claims experience.
- Proactively identify process gaps or opportunities and contribute to continuous improvement efforts and enterprise initiatives.
- 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.
Requirements
- College degree or equivalent experience preferred.
- Minimum 5 years of experience handling Short Term Disability claims
- Strong understanding of Short term Disability claim adjudication and relevant federal/state regulations (e.g., FMLA, ERISA, HIPAA, ADA).
- Experience partnering with clinical/vocational professionals to support RTW efforts and complex decisioning.
- Effective verbal and written communication skills with the ability to explain complex decisions clearly and empathetically.
- Demonstrated problem-solving and analytical skills with a customer-first mindset.
- Highly organized and detail-oriented with the ability to manage competing priorities.
- Proven ability to mentor peers and support a collaborative team environment.
- Proficiency with claims administration platforms and workflow/documentation tools.
- Demonstrated ability to work independently and exercise sound judgment.
- Growth mindset with a commitment to continuous learning and improvement.
- Strong time management and the ability to thrive in a fast-paced, evolving environment.
- Experience supporting cross-functional or enterprise initiatives and change management efforts.
Benefits
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Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Short Term Disability claimsclaim adjudicationregulatory complianceFMLAERISAHIPAAADAdocumentationprocess improvementclaims administration
Soft Skills
communication skillsproblem-solvinganalytical skillsorganizational skillsdetail-orientedmentoringcollaborationindependent judgmenttime managementadaptability