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Senior Life Claims Specialist
Pacific Life. Serve as a subject matter expert on Life claim practices .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Life Insurance claims management, including adjudication, eligibility evaluation, and compliance with regulatory standards. Possesses strong analytical, communication, and mentoring skills to support team development and enhance claims processes.
Highest-signal resume keywords
Life Insurance Claims ManagementAdjudication of Complex ClaimsKnowledge of FMLA, ERISA, HIPAAAdvanced Analytical SkillsStrong Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AdjudicationPolicy InterpretationEligibility EvaluationBenefit CalculationDocumentation ManagementProcess ImprovementClaims ComplianceClaims Administration SystemsWorkflow ToolsCritical Thinking
Soft Skills
EmpathyCustomer-Centric ApproachMentoringOrganizational SkillsAdaptability
Industry Keywords
Group Life InsuranceContestability ReviewsBeneficiary DisputesClaims Compliance StandardsConfidentialityProfessionalismIntegrity
About the role
Key responsibilities & impact- Serve as a subject matter expert on Life claim practices
- Consult on best practices and contribute to internal procedures, workflows, and system requirements
- Mentor and support onboarding of new team members
- Identify process gaps and contribute to continuous improvement and enterprise initiatives
- Manage Group Life insurance claims from initial review through resolution
- Evaluate eligibility and validate beneficiary information using policy provisions
- Gather and analyze beneficiary, autopsy, accident, medical, financial, and other claim documentation
- Make timely and accurate claim decisions
- Document decisions, rationale, and customer interactions
- Communicate clearly and empathetically with claimants, beneficiaries, employers, and internal stakeholders
- Collaborate across business functions for a seamless and compliant claims experience
- Adapt to changing priorities, business needs, and regulatory requirements
- Maintain confidentiality, professionalism, and integrity
- Perform other duties as assigned
Requirements
What you’ll need- Bachelor’s degree or equivalent work experience preferred
- 5–7+ years of Life Insurance claims experience required, including adjudication of complex claims
- Experience with contestability reviews, exclusions, and beneficiary disputes
- Expertise investigating, evaluating, and adjudicating life insurance claims from initial notice through claims decision
- Ability to interpret policy language, contractual provisions, and beneficiary designations
- Strong knowledge of group life insurance policies
- Knowledge of FMLA, ERISA, HIPAA, state insurance regulations, and claims compliance standards
- Ability to manage a full caseload independently and prioritize competing demands
- Advanced analytical and critical thinking skills
- Ability to evaluate medical records, cause of death, financial documentation, and legal instruments
- Strong communication skills with beneficiaries, funeral homes, attorneys, medical providers, and internal partners
- Customer-centric claims philosophy with empathy, care, and respect
- Ability to navigate grief and emotionally complex situations sensitively
- Highly organized and detail-oriented
- Ability to ensure accurate benefit calculations, thorough documentation, and complete claim file management
- Ability to work independently as a subject matter expert and mentor less experienced team members
- Ability to manage multiple priorities and adapt in a fast-paced environment
- Experience with claims administration systems and workflow tools
Benefits
Comp & perks- Medical, Dental, Vision
- Wellbeing Reimbursement Account for employees and eligible dependents
- Paid Time Off
- Holiday Schedules
- Financial Planning Time Off
- Paid Parental Leave
- Adoption Assistance Program
- Competitive 401k savings plan with company match
- Additional 401k contribution regardless of participation
- Flexible benefits tailored to employee needs
- Diversity and inclusion support