Senior Supplemental Health Claims Specialist

Location: Northern

## Senior Supplemental Health Claims Specialist Apply:
Omaha NE-6750:
Tennessee-Remote:
Full time:
Posted Today:
R17876
*
* Job Description:

** 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 Senior Supplemental Health Claims Specialist to join our Team in Omaha, NE or remote in Tennessee.  

As a Senior Supplemental Health Claims Specialist you'll move Pacific Life and your career, forward by administering complex Supplemental Health and other voluntary benefits claims. You'll fill an existing role that sits on a team in the Workforce Benefits Division.  
** How you’ll help move us forward:
*** 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.  
** The experience you bring:
*** 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…