Operations Claims Specialist
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. We’re actively seeking a talented Operations Claims professional to join our Operations Claims processing team within the Consumer Markets Division (CMD) in Omaha, NE or Charlotte, NC. This role follows a hybrid schedule of one day a week in office. As part of the Claims processing team, you’ll move Pacific Life, and your career, forward by ensuring accurate, timely, and compliant processing of insurance claims while delivering exceptional service to customers and internal partners. You will review and process contestable and non-contestable death and living claims on both annuity contracts and life insurance policies. This position may be filled at the Operations Claims Associate, Operations Claims Specialist, Sr. Operations Claims Specialist, or Sr. Operations Claims Analyst level based on experience and business needs, and we are open to hiring across all levels.
Requirements
- 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
- Ability to balance accuracy and efficiency in a fast-paced environment
- Strong written and verbal communication skills, including handling sensitive situations with empathy
- Ability to work both independently and collaboratively
Nice To Haves
- Experience with life insurance and/or annuity claims
- Experience handling contestable claims or investigations
- Experience with training, mentoring, or coaching
Responsibilities
- 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
- Balance accuracy, efficiency, and risk mitigation in claims decisions
- Identify and report errors, process gaps, and improvement opportunities
- Follow established procedures, job aids, and knowledge resources
- Support workload balancing and queue management priorities
- Partner with peers, leadership, and cross-functional teams to resolve issues
- Support team workflow needs and participate in functional rotations
- Contribute to a professional, collaborative team environment
- Provide mentoring, coaching, and peer training (Sr. Operations Claims Specialist)
- Conduct quality reviews and identify trends (Sr. Operations Claims Specialist)
- Support process improvements, documentation updates, and project initiatives (Sr. Operations Claims Specialist)
- Serve as a subject matter expert for complex or escalated claims (Sr. Operations Claims Specialist)
Benefits
- Medical
- Dental
- Vision
- Wellbeing Reimbursement Account
- Paid Time Off
- Holiday Schedules
- Financial Planning Time Off
- Paid Parental Leave
- Adoption Assistance Program
- Competitive 401k savings plan with company match and an additional contribution regardless of participation
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
