Claims Operations Specialist Jobs (NOW HIRING)

Pacific Life is seeking talentedOperations Quality Assurance Specialiststo join our Consumer Markets Division in Omaha, NE or Charlotte, NC.

In this role, you will play a critical part in ensuringthe accuracy, compliance, and quality of lifeinsuranceclaims processing activities. You will conduct detailed transaction audits,identifytrendsand root causes, andprovideactionable insights that improve operational performance, reduce risk, and strengthen service quality across the organization.

This is an excellent opportunity for individuals looking to grow their career in operations quality, risk, and process improvement within a leading financial services organization.

HowYou'llMake an Impact:

• Perform detailed quality audits of claims transactions across Pay QA, Set-Up QA, and Follow-Up QA, including claim payment accuracy,interest review and calculation, post-death interest,initial claim setup, documentation, beneficiary/payee information, follow-up requirements, and completion of required claim actions

• Evaluateclaimsprocessing for adherence toestablishedprocedures,authority guidelines,controls, regulatory requirements,service standards, and customer-focused claim handling expectations

• Document QA findings for pay, set-up, and follow-up reviews, including defect type, root cause, severity, risk impact, coaching opportunity, and recommended corrective action

• Partner withclaimsleaders,processors,trainers, andbusiness partnersto clarify expectations, reinforce procedures,and support corrective action planningwhen quality gaps areidentified

• Analyze QA results toidentifytrends in payment errors,setupaccuracy, missing or incomplete documentation, follow-up timeliness, procedural gaps, and recurring claim handling themes

• Contribute to claims QA reporting and insight development that helps leadership understand risk areas, training needs, workload impacts, and opportunities to improve claim quality and consistency

• Support continuous improvement initiatives aimed at increasing quality, efficiency, and consistency

• Participate in calibration sessionsfor Pay QA, Set-Up QA, and Follow-Up QAto ensurereviewaccuracy,consistent scoring, and alignment acrossQAreviewersand claims operations

How you'll help move us forward:

• Consistently apply sound judgment and accountability when evaluatingpay accuracy,interest review and calculation, post-death interest,claim setup completeness, follow-up activity, documentationquality,andadherenceto claims procedures

• Identifymeaningful trends and root causes across Pay QA, Set-Up QA, and Follow-Up QA that help reduce repeat errors, strengthen controls, and improve the customer claim experience

• Delivertimely,accurate, objective, and actionableQAfindingsthroughclear documentation, consistent scoring, and constructivecommunicationwith claims processors and leaders

• Build strong partnerships withclaimsoperations stakeholders to supportcoaching,quality improvement, procedural alignment, and consistent claim handling practices

• Contribute to a culture of continuous improvementby using QA insights to support training, reduce risk, improve claim accuracy,andstrengthenoperational excellence

The experience you bring:

• 1-4 years of experience inclaims processing, claimsquality assurance, auditing, compliance,insurance operations, financial operations, or operational risk/control environments

• Strong analytical and critical thinking skills withtheability toidentifyclaim processingpatterns,root causes, procedural gaps, and risk trends across QA review results

• Exceptional attention to detail and documentation accuracy

• Ability to interpret and applyclaimsprocedures consistently while exercising sound judgmentin pay, set-up, and follow-up review scenarios

• Strong communicationand partnership skills withtheability to provide constructive, fact-basedfeedbackto claims processors, leaders, and training partners

• Ability to manage multiple priorities in a fast-paced environment

• Demonstrated adaptability and learning agility

What makes you stand out:

• Experience inlifeinsuranceclaims, financial services, banking, healthcare claims, or other regulated operational environments

• Prior experience with claims quality assurance, claim payment review, claim setup review, follow-up review, audit, compliance, or controls work

• Knowledge of claims operations, life insurance claim handling, beneficiary/payee review, documentation requirements,payment controls, interest calculation, and post-death interest review

• Experience supporting process improvement or operational excellence initiatives

Recruiting Process

• Initial resume review

• Candidates selected for next steps will be notified via email

• Finalists will complete a recorded video interview throughHireVue

Position Level & Compensation

This role may be filled at either the Specialist orSr Specialist level based on qualifications and experience.

Compensation by Level:

• Analyst I: Omaha: $32 - $37 per hour/Charlotte: $34 - $39 per hour

• Analyst II:Omaha: $36 - $41 per hour/ Charlotte: $38 - $43 per hour

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