Operations Claims Specialist

Pacific Life

Operations Claims Specialist at Pacific Life ensuring accurate and timely processing of claims. Collaborating with customers and internal partners while adhering to regulatory standards.

Posted 5/17/2026full-timeOmaha • New York, North Carolina • 🇺🇸 United StatesMid-LevelSenior💰 $24 - $43 per hourWebsite

About the role

Key responsibilities & impact

Review claims against contract and policy provisions to ensure accuracy and appropriate resolution
Process transactions accurately with complete documentation and payment validation
Identify and document outstanding requirements and required next steps
Maintain clear and detailed claim notes for continuity of service
Ensure adherence to regulatory, compliance, and procedural standards
Respond to customer and internal partner inquiries via phone and email
Communicate clearly, professionally, and with empathy, especially in sensitive claim situations
Research and resolve claim-related inquiries within service level expectations
Escalate complex or high-risk issues appropriately
Identify and report errors, process gaps, and improvement opportunities
Support workload balancing and queue management priorities
Partner with peers, leadership, and cross-functional teams to resolve issues
Provide mentoring, coaching, and peer training (for Sr. Operations Claims Specialist)
Conduct quality reviews and identify trends

Requirements

What you’ll need

Operations Claims Associate: 0–2 years of operations or insurance-related experience
Operations Claims Specialist: 2–3+ years of claims processing experience with demonstrated proficiency
Sr. Operations Claims Specialist: 3+ years of advanced claims experience, including complex or contestable claims
Sr. Operations Claims Analyst: 5+ years of experience with expertise in complex or contestable claims
Strong analytical, critical thinking, and problem-solving skills
High attention to detail with ability to manage multiple priorities
Strong written and verbal communication skills, including handling sensitive situations with empathy
Ability to work both independently and collaboratively

Benefits

Comp & perks

Your wellbeing is important to Pacific Life, and we’re committed to providing you with flexible benefits that you can tailor to meet your needs.
Prioritization of your health and well-being including Medical, Dental, Vision, and Wellbeing Reimbursement Account that can be used on yourself or your 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 match and an additional contribution regardless of participation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims processingdocumentationpayment validationquality reviewsregulatory complianceerror identificationprocess improvementtransaction processingservice level expectationsqueue management

Soft Skills

analytical skillscritical thinkingproblem-solvingattention to detailcommunication skillsempathyindependencecollaborationmentoringcoaching