Operations Claims Specialist

Operations Claims Professional

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.

We're actively seeking a talented Operations Claims professional to join our Operations Claims processing team within the Consumer Markets Division (CMD) in Omaha, NE or Charlotte, NC. This role follows a hybrid schedule of one day a week in office.

As part of the Claims processing team, you'll move Pacific Life, and your career, forward by ensuring accurate, timely, and compliant processing of insurance claims while delivering exceptional service to customers and internal partners. You will review and process contestable and non-contestable death and living claims on both annuity contracts and life insurance policies.

This position may be filled at the Operations Claims Associate, Operations Claims Specialist, Sr. Operations Claims Specialist, or Sr. Operations Claims Analyst level based on experience and business needs, and we are open to hiring across all levels.

How you'll help move us forward:

• Claims Processing & Adjudication
• Review claims against contract and policy provisions to ensure accuracy and appropriate resolution
• Process transactions accurately with complete documentation and payment validation
• Identify and document outstanding requirements and required next steps
• Maintain clear and detailed claim notes for continuity of service
• Ensure adherence to regulatory, compliance, and procedural standards
• Customer & Partner Communication
• Respond to customer and internal partner inquiries via phone and email
• Communicate clearly, professionally, and with empathy, especially in sensitive claim situations
• Research and resolve claim-related inquiries within service level expectations
• Escalate complex or high-risk issues appropriately
• Operational Excellence & Risk Management
• Balance accuracy, efficiency, and risk mitigation in claims decisions
• Identify and report errors, process gaps, and improvement opportunities
• Follow established procedures, job aids, and knowledge resources
• Support workload balancing and queue management priorities
• Collaboration & Team Support
• Partner with peers, leadership, and cross-functional teams to resolve issues
• Support team workflow needs and participates in functional rotations
• Contribute to a professional, collaborative team environment
• Leadership, Training & Continuous Improvement (Sr. Operations Claims Specialist)
• Provide mentoring, coaching, and peer training
• Conduct quality reviews and identify trends
• Support process improvements, documentation updates, and project initiatives
• Serve as a subject matter expert for complex or escalated claims

The experience you bring:

• Operations Claims Associate: 02 years of operations or insurance-related experience
• Operations Claims Specialist: 23+ years of claims processing experience with demonstrated proficiency
• Sr. Operations Claims Specialist: 3+ years of advanced claims experience, including complex or contestable claims
• Sr. Operations Claims Analyst: 5+ years of experience with expertise in complex or contestable claims
• Strong analytical, critical thinking, and problem-solving skills
• High attention to detail with ability to manage multiple priorities
• Ability to balance accuracy and efficiency in a fast-paced environment
• Strong written and verbal communication skills, including handling sensitive situations with empathy
• Ability to work both independently and collaboratively

What makes you stand out:

• Experience with life insurance and/or annuity claims
• Experience handling contestable claims or investigations
• Experience with training, mentoring, or coaching

Education Requirements:

• Bachelor's degree or equivalent combination of education and experience

Level Differentiation & Compensation:

Compensation will vary depending on level, experience, and qualifications, and location.

Operations Claims Associate

• Entry-level role focused on developing foundational claims knowledge and skills
• Omaha Compensation: $24 - $26/hr.
• Charlotte Compensation: $25 - $27/hr.

Operations Claims Specialist

• Independently performs advanced claims transactions and meets performance expectations
• Omaha Compensation: $26 - $28/hr.
• Charlotte Compensation: $27 - $29/hr.

Sr. Operations Claims Specialist

• Handles complex or contestable claims and contributes to training, quality, and process improvement efforts
• Omaha Compensation: $32 - $34
• Charlotte Compensation: $33 - $36

Sr. Operations Claims Analyst

• Serves as subject matter expert and leads complex investigations and cross-functional initiatives
• Omaha Compensation: $39 - $41
• Charlotte Compensation: $41 - $43

Your Benefits Start Day 1

Your wellbeing is important to Pacific Life, and we're committed to providing you with flexible benefits that you can tailor to meet your needs. Whether you are focusing on your physical, financial, emotional, or social wellbeing, we've got you covered.

• Prioritization of your health and well-being including Medical, Dental, Vision, and Wellbeing Reimbursement Account that can be used on yourself or your eligible dependents
• Generous paid time off options including: Paid Time Off, Holiday Schedules, and Financial Planning Time Off
• Paid Parental Leave as well as an Adoption Assistance Program
• Competitive 401k savings plan with company match and an additional contribution regardless of participation

You Can Be Who You Are

We are committed to a culture of diversity and inclusion that embraces the authenticity of all employees, partners and communities. We support all employees to thrive and achieve their fullest potential.

EEO Statement:

Pacific Life Insurance Company is an Equal Opportunity /Affirmative Action Employer, M/F/D/V. If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at Pacific Life Insurance Company.