PFML- Absence Management Claims Consultant

PFML-Absence Management Claims Consultant

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 PFML-Absence Management Claims Consultant to join our Workforce Benefits Division. As a PFML Absence Management Claims Consultant, you'll play a key role in building and delivering a best-in-class Paid Family and Medical Leave claims experience. This role will serve as a PFML subject matter expert and will be responsible for helping design and build the future-state PFML claims operation.

The PFML Claims Consultant will partner closely with Product, Technology, Legal, Compliance, and Operations teams to define business requirements, support system configuration and testing, develop workflows, create claims procedures and training materials, drive process improvements, and ensure regulatory requirements are effectively translated into scalable operational solutions. This individual will help build the foundation for PFML claims administration while delivering an empathetic, compliant, and customer-centered experience for employees and employers.

The ideal candidate combines strong technical expertise, regulatory knowledge, critical thinking, and compassion while helping customers navigate important life events.

How you'll help move us forward:

• Serve as a key business partner in the design, implementation, and ongoing enhancement of Pacific Life's Paid Family and Medical Leave (PFML) capabilities.
• Partner closely with Product Owners, Business Analysts, Technology teams, and external vendors to define business requirements, user stories, workflows, business rules, and system functionality needed to support PFML administration.
• Act as the PFML claims subject matter expert (SME) throughout the product development lifecycle, including requirements gathering, solution design, testing, implementation, and production support.
• Help design and build the end-to-end PFML claims experience, ensuring processes are scalable, compliant, efficient, and customer focused.
• Develop and maintain claims procedures, workflows, job aids, training materials, and operational documentation aligned with state regulations, product design, and system capabilities.
• Participate in system configuration reviews, user acceptance testing (UAT), workflow validation, defect identification, and implementation of new PFML products and enhancements.
• Serve as a SME and monitor evolving state PFML legislation and regulatory requirements and translate business and compliance requirements into operational processes and system functionality.
• Consult on industry best practices and recommend innovative solutions to improve the customer experience, claims outcomes, operational efficiency, and automation opportunities.
• Partner closely with Legal, Compliance, Employer Services, Customer Service, Operations, Product, and Technology teams to ensure compliant and effective administration of PFML programs.
• Administer and adjudicate Paid Family and Medical Leave (PFML) claims from intake through resolution, ensuring timely, accurate, and compliant claim decisions.
• Interpret state-specific eligibility requirements, benefit calculations, waiting periods, leave durations, and documentation requirements.
• Effectively communicate claim decisions, requirements, next steps, and benefit information to claimants, employers, brokers, and internal partners.
• Demonstrate an empathetic and customer-centric mindset while assisting employees during significant family, medical, and caregiving events.
• Identify opportunities to improve customer experience, operational efficiency, quality, and compliance within the…