Product Manager, Flight Efficiency
Boeing
Senior Supplemental Health Claims Specialist
Pacific Life
full-time
Posted on:
Origin: • 🇺🇸 United States • California
Visit company websiteSalary
💰 $66,960 - $81,840 per year
Job Level
Senior
About the role
- Serve as a subject matter expert across all aspects of supplemental health claims administration—consulting on best practices and recommending innovative, scalable solutions.
- Maintain organizational service standards across a caseload of varying size and complexity by using strategic, analytical, and empathetic approaches.
- Demonstrate deep knowledge of supplemental health policies, procedures, and contracts, including policy definitions, provisions, exclusions, riders, waivers, and applicable regulatory and statutory requirements.
- Build and refine claims workflows, procedures, and documentation in alignment with system capabilities, product features, and compliance expectations.
- Accurately adjudicate claims using sound judgment and comprehensive technical analysis, ensuring timely and fair liability determinations and benefit payments.
- Provide clear, well-documented rationales for claims decisions and communicate outcomes to internal and external stakeholders with clarity and professionalism.
- Develop and maintain a working knowledge of claims systems, and effectively leverage tools and data for adjudication, workflow management, and process improvements.
- Lead and/or participate in training and onboarding for new team members.
- Mentor peers and foster knowledge-sharing across the team.
- Collaborate with cross-functional teams, including Compliance, Legal, Intake/Admin, Clinical Services, and Billing to ensure seamless and compliant claims handling.
- Partner with specialized resources to support integrated and complex claim strategies.
- Support coordinated claim experiences across lines of business through well-communicated transition processes.
- Contribute to process improvement efforts and special projects by offering innovative ideas and a continuous improvement mindset.
- Actively participate in change management and enterprise initiatives, ensuring that updates to regulations or business priorities are reflected in daily operations.
- Stay current on industry trends and evolving regulations to maintain compliant and customer-focused claims practices.
- Demonstrate a high level of discretion when handling sensitive or confidential information.
Requirements
- College degree or equivalent experience preferred
- 5+ years of Supplemental Health experience preferred
- Needs to be an effective communicator with externally facing presence
- Customer-centric with problem-solving skillset
- Requires strong analytical skills
- Demonstrated time management and organizational skills
- Detail oriented with ability to make balanced and objective decisions with at the highest degree of integrity
- Ability to utilize logic and analytic discipline to solve problems and identify viable solutions
- Effective communication skills both verbal and written
- Demonstrated time management and organizational skills
- Ability to manage multiple priorities and approach work with an agile mindset
- Will need to gain expert knowledge of Pacific Life’s workforce benefits platforms such as claims administration system and workflow tools
