Hybrid Claims Support Specialist II

at Pacific Life

• Job title: Claims Support Specialist II
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $20 - $24 per hour
• Degree requirement: No Education Requirement
• Location requirements: Hybrid, United States

About the role

• Claims Support Specialist providing empathetic service in the Workforce Benefits division. Gathering information for claim adjudication while ensuring excellent customer experience through communication and collaboration.

Responsibilities

• Gather information (via phone, fax, or e-mail) that is necessary for claim adjudication
• Review 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
• Independently manage worklist and complete tasks within established turn-around time expectations
• Communicate effectively across multiple channels, including phone, e-mail, and letter
• Follow outlined steps in a checklist or workflow with a high degree of accuracy and consistency
• Communicate clearly with outside partners such as physicians’ offices and other vendors
• Accurately summarize large quantities of medical information and data into actionable, usable data summaries
• Make basic claims decisions based on the information available to them and adherence to established workflows
• 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.

Requirements

• 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
• Demonstrated ability to use sound judgement and discretion regarding confidential information
• Process improvement mindset – ability to identify trends and suggest process improvements to deliver an improved level of customer experience
• Willingness to accept coaching, and ability to provide coaching and feedback to peers, teammates, and leaders

Benefits

• Your Benefits Start Day 1
• 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