Claims Support Specialist II at Pacific Life

Omaha, Nebraska, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Insurance, Workforce BenefitsIndustries

Requirements

College degree or equivalent experience preferred
3+ years of progressive experience in a support or customer service role
Ability to independently manage worklist and complete tasks within established turn-around time expectations
Ability to communicate effectively across multiple channels, including phone, e-mail, and letter
Ability to follow outlined steps in a checklist or workflow with a high degree of accuracy and consistency
Ability to communicate clearly with outside partners such as physicians’ offices and other vendors
Ability to accurately summarize large quantities of medical information and data into actionable, usable data summaries
Ability to make basic claims decisions based on the information available and adherence to established workflows
Process improvement mindset – ability to identify trends and suggest process improvements
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
Willingness to accept coaching, and ability to provide coaching and feedback to peers, teammates, and leaders
Demonstrated ability to use sound judgement and discretion regarding confidential information
Business background, including group benefits experience with understanding of reviewing and applying policy provisions (what makes you stand out)

Responsibilities

Performs tasks assigned by Claims Specialist to gather information (via phone, fax, or e-mail) necessary for claim adjudication
Reviews 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
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
Ensures job performance meets 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
Performs other duties as assigned

Skills

Key technologies and capabilities for this role

Claims ProcessingCustomer CommunicationPhone SkillsEmail CommunicationClaimant CorrespondenceMedical DocumentationWorkflow ManagementData AccuracyVendor Coordination

Questions & Answers

Common questions about this position

What locations can I work from for this Claims Support Specialist role?

The position is available in Omaha, NE or Chattanooga, TN.

What is the salary for the Claims Support Specialist II position?

This information is not specified in the job description.

What key skills are required for this role?

Required skills include strong communication skills (written and verbal), ability to accurately summarize medical information, independent management of worklists within turnaround times, and a process improvement mindset.

What is the company culture like at Pacific Life?

Pacific Life emphasizes collaboration, innovation, work-life balance, continuous improvement, and making a positive impact, with a supportive environment that encourages coaching, feedback, and team contributions.

What makes a strong candidate for this position?

Strong candidates demonstrate effective communication across channels, accuracy in following workflows, ability to handle confidential information with sound judgement, and a customer-centric approach with process improvement ideas.

Pacific Life

About Pacific Life

Newport Beach, CaliforniaHeadquarters

1868Year Founded

$189.4MTotal Funding

N/ACompany Stage

Fintech, Financial ServicesIndustries

1,001-5,000Employees

Benefits

Health Insurance

Paid Vacation

Paid Parental Leave

Adoption Assistance

401(k) Retirement Plan

401(k) Company Match

Risks

Increased competition in annuities market from companies like Prudential and MetLife.

Potential financial exposure from significant real estate investments.

Integration challenges with Selerix could affect customer satisfaction.

Differentiation

Pacific Life partners with T. Rowe Price for innovative Lifetime Income solutions.

Recognized as a top community-minded company, enhancing brand reputation and trust.

Real-time integration with Selerix improves benefits administration accuracy and efficiency.

Upsides

Lifetime Income solution attracts clients seeking secure retirement options.

Enhanced annuity products offer flexibility and growth, increasing product attractiveness.

Strong real estate financing position opens more sector opportunities.

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