Senior Supplemental Health Claims Specialist

Pacific Life

. Serve as a subject matter expert across supplemental health claims administration .

Posted 10/9/2026full-timeUnited StatesSenior💰 $69,390 - $84,810 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in supplemental health claims administration, including adjudication, workflow optimization, and compliance with regulatory requirements. Possesses strong analytical and communication skills to effectively manage claims processes and collaborate with cross-functional teams.

Highest-signal resume keywords

Supplemental Health ExperienceClaims Administration SystemsAnalytical SkillsEffective CommunicationChange Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationWorkflow OptimizationRegulatory ComplianceProcess ImprovementDocumentationDecision MakingProblem SolvingData AnalysisTime ManagementDetail Orientation

Soft Skills

Effective CommunicationCustomer-Centric ApproachOrganizational SkillsAgile MindsetMentoring

Tools & Technologies

Claims SystemsWorkflow ToolsData Management Tools

Industry Keywords

Supplemental Health PoliciesClaims WorkflowsLiability DeterminationsBenefit PaymentsCross-Functional CollaborationEnterprise InitiativesIndustry Trends

About the role

Key responsibilities & impact

Serve as a subject matter expert across supplemental health claims administration
Maintain organizational service standards across caseloads of varying size and complexity
Apply knowledge of supplemental health policies, procedures, contracts, definitions, provisions, exclusions, riders, waivers, and regulatory requirements
Build and refine claims workflows, procedures, and documentation
Adjudicate claims and make timely, fair liability determinations and benefit payments
Document claims decisions and communicate outcomes to internal and external stakeholders
Use claims systems, workflow tools, and data for adjudication and process improvement
Lead or participate in training and onboarding; mentor peers and foster knowledge sharing
Collaborate with Compliance, Legal, Intake/Admin, Clinical Services, and Billing
Partner with specialized resources on integrated and complex claim strategies
Support coordinated claim experiences across lines of business
Contribute to process improvements and special projects
Participate in change management and enterprise initiatives
Monitor industry trends and evolving regulations
Handle sensitive and confidential information with discretion

Requirements

What you’ll need

College degree or equivalent experience preferred
5+ years of Supplemental Health experience preferred
Effective communicator with externally facing presence
Customer-centric with problem-solving skillset
Strong analytical skills
Demonstrated time management and organizational skills
Detail oriented with ability to make balanced and objective decisions with the highest degree of integrity
Ability to utilize logic and analytic discipline to solve problems and identify viable solutions
Effective verbal and written communication skills
Ability to manage multiple priorities and approach work with an agile mindset
Ability to gain expert knowledge of Pacific Life’s workforce benefits platforms, including claims administration systems and workflow tools
Growth mindset with commitment to continuous learning and improvement
Experience supporting cross-functional or enterprise initiatives and change management efforts

Benefits

Comp & perks

Medical, Dental, Vision, and 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
Additional 401k contribution regardless of participation
Flexible benefits tailored to employee needs