Claims Support Specialist II

Pacific Life

107d • $19 - $24 • Remote

About The Position

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 Claims Support Specialist to join our team. This role can be full remote or hybrid (4 days in the office per week), if you are located within 50 miles of our Omaha, NE or Newport Beach CA offices. As an Claims Support Specialist, you'll play a key role in building and providing a first-class empathetic and frictionless service experience in the Workforce Benefits division. Within the Workforce Benefits Division, we are striving to build an industry-leading customer experience through a unique, standardized product mix and focusing on digital-first solutions. That said, we recognize the importance of customer service and human-to-human interaction and are working to strike the right balance of technology when helpful but human interaction when necessary. For that reason, we understand just how important the Claims Support Specialist role is at helping us achieve our overall customer experience objectives.

Requirements

• Strong communication skills - both written and verbal - including the ability to anticipate and address next questions/root cause.
• Ability to communicate effectively in a customer-centric and professional demeanor.
• Demonstrated ability to use sound judgement and discretion regarding confidential information.

Nice To Haves

• Process improvement mindset - ability to identify trends and suggest process improvements to deliver an improved level of customer experience.
• Willingness to accept coaching, and ability to provide coaching and feedback to peers, teammates, and leaders.

Responsibilities

• Gather information (via phone, fax, or e-mail) that is necessary for claim adjudication.
• Review new claims for eligibility requirements, creates and sends claimant letters, and communicates with claimants, brokers, plan administrators, or physicians to obtain information necessary to triage claims to a Claims Specialist.
• Completes requests assigned by Claims Specialist to obtain medical documentation and coordinates payment for records when necessary.
• Independently manage worklist and complete tasks within established turn-around time expectations.
• Communicate effectively across multiple channels, including phone, e-mail, and letter.
• Follow outlined steps in a checklist or workflow with a high degree of accuracy and consistency.
• Communicate clearly with outside partners such as physicians' offices and other vendors.
• Accurately summarize large quantities of medical information and data into actionable, usable data summaries.
• Make basic claims decisions based on the information available to them and adherence to established workflows.
• Participates and contributes to team meetings or special tasks and assignments and brings innovative ideas and a continuous improvement mindset to the department.
• Consistently supports and promotes change management and/or departmental/enterprise initiatives within assigned area(s) of responsibility.
• Fosters strong partnerships and collaborates with key internal areas, such as Claims, Compliance/Legal, Support Services, Intake/Admin, etc.
• Job performance must meet department standards for work prioritization, productivity, quality and timeliness.
• Identifies, understands and ensures that actions, behaviors and decisions are consistent with the department, division and Pacific Life Mission & Vision.
• Perform other duties as assigned.

Benefits

• Prioritization of your health and well-being including Medical, Dental, Vision, and a 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities