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Claims Compliance Jobs in Raleigh, NC (NOW HIRING)

DAN

Claims Coordinator

Durham, NC · Hybrid

Claims, QA & Compliance Officer JOB SUMMARY The Claims Coordinator is responsible for overseeing and efficiently processing member benefit and insurance claims. You will work closely with insurance ...

Divers Alert Network

Claims Coordinator

Durham, NC · On-site

Claims, QA & Compliance Officer JOB SUMMARY The Claims Coordinator is responsible for overseeing and efficiently processing member benefit and insurance claims. You will work closely with insurance ...

DAN

Claims Coordinator

Durham, NC · On-site

$50K - $55K/yr

Claims, QA & Compliance Officer JOB SUMMARY The Claims Coordinator is responsible for overseeing and efficiently processing member benefit and insurance claims. You will work closely with insurance ...

DAN

Claims Director

Durham, NC · On-site

$130K/yr

This role ensures timely, accurate, and compliant claims handling while promoting exceptional customer service, effective risk management, and continuous operational improvement. The Director of ...

DAN

Claims Director

Durham, NC · Hybrid

This role ensures timely, accurate, and compliant claims handling while promoting exceptional customer service, effective risk management, and continuous operational improvement. The Director of ...

Divers Alert Network

Claims Director

Durham, NC · On-site

This role ensures timely, accurate, and compliant claims handling while promoting exceptional customer service, effective risk management, and continuous operational improvement. The Director of ...

Builders Mutual Insurance

Claims Processor I

Raleigh, NC · On-site

$16.50 - $21/hr

Process Entity Entry (I-9) to ensure compliance. * Assist in training team members. * Photocopying ... claims experience or an equivalent combination of education and experience. * PC computer skills ...

Builders Mutual

Claims Processor I

Raleigh, NC · On-site

$16.50 - $21/hr

Process Entity Entry (I-9) to ensure compliance. * Assist in training team members. * Photocopying ... claims experience or an equivalent combination of education and experience. * PC Computer skills ...

Iatinsurancegroup

Claims Major Case Director

Raleigh, NC · On-site +1

$92K - $130K/yr

This role is a true complex claims handling role that is tasked with managing those claims that are ... Sets accurate/timely loss/expense reserves in compliance with Claim Guidelines. * Evaluates ...

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All JobsClaims Compliance JobsClaims Compliance Jobs in Raleigh, NC

Claims Compliance information

See Raleigh, NC salary details

$38.9K

$59.9K

$89.4K

How much do claims compliance jobs pay per year?

As of Aug 27, 2026, the average yearly pay for claims compliance in Raleigh, NC is $59,880.00, according to ZipRecruiter salary data. Most workers in this role earn between $52,500.00 and $63,700.00 per year, depending on experience, location, and employer.

What is the difference between Claims Compliance vs Claims Adjuster?

AspectClaims ComplianceClaims Adjuster
Required CredentialsCertifications in compliance regulations, insurance lawsLicenses in insurance adjusting, certifications like AIC or CPCU
Work EnvironmentOffice-based, compliance departments, insurance companiesField or office-based, investigating claims, interacting with clients
Employer & Industry UsageInsurance companies, regulatory agenciesInsurance carriers, third-party claims firms

Claims Compliance professionals focus on ensuring insurance claims adhere to legal and regulatory standards, while Claims Adjusters evaluate and settle claims directly with policyholders. Both roles require insurance knowledge, but Claims Compliance emphasizes regulatory adherence, whereas Claims Adjusters handle claim investigations and payouts.

What are popular job titles related to Claims Compliance jobs in Raleigh, NC?

For Claims Compliance jobs in Raleigh, NC, the most frequently searched job titles are:

What job categories do people searching Claims Compliance jobs in Raleigh, NC look for?

The top searched job categories for Claims Compliance jobs in Raleigh, NC are:

Claims Compliance jobs near you
Infographic showing various Claims Compliance job openings in Raleigh, NC as of August 2026, with employment types broken down into 94% Full Time, and 6% Part Time. Highlights an 75% In-person, and 25% Remote job distribution, with an average salary of $59,880 per year, or $28.8 per hour.

Claims Coordinator

Durham, NC • Hybrid

DAN
Construction • 11 - 50 employees
Learn more about DANexternal

Full-time

Posted 22 days ago

Job description

Claims Coordinator
POSITION OVERVIEW


FLSA: Non-Exempt, Full Time


Department: Claims


Primary Worksite: 6 West Colony Place, Durham, NC


Supervisory Responsibilities: None


Reports to: Claims, QA & Compliance Officer


JOB SUMMARY


The Claims Coordinator is responsible for overseeing and efficiently processing member benefit and insurance claims. You will work closely with insurance carriers, members, and healthcare providers to ensure that claims are handled in a timely and accurate manner.
Supports DAN members throughout the claims process by coordinating with insurance carriers and facilitating timely and accurate claim handling. Calculates applicable benefits and prepares claim recommendations for underwriter review and final determination.


Common duties include reviewing claim forms, verifying information, contacting members and providers to gather additional information, developing recommendations, and forwarding claims to carriers for payment. The Claims Coordinator will also assist with subrogation and the coordination of claims among carriers.


CORE RESPONSIBILITIES


Verify coverage, calculate benefit payments, and communicate claim determinations to members and providers.
Review and validate claim submissions for accuracy, completeness, and compliance with applicable requirements.
Coordinate with members, insurance adjusters, and other stakeholders to obtain required documentation and information.
Review, compile, and organize claim documentation for submission to the appropriate carrier.
Process claims in a timely manner while maintaining accurate and complete records within the department's claims management system.
Prepare claim recommendations (pay/deny) and forward processed claims to the appropriate carrier for determination.
Communicate with DAN and program assistance partners regarding complex, urgent, or ongoing cases.
Support members by helping ensure needed care and services are provided promptly and professionally; guide members through the claims process and assist in resolving issues or discrepancies.
Serve as a liaison between DAN Medical Services, DAN Claims, and third-party assistance companies for emergent cases and situations requiring coordinated support.
Participate in a rotating on-call schedule, including providing 24-hour emergency benefit verification support.
Pursue subrogation opportunities and other potential reimbursement avenues through third-party carriers.
Adhere to all policies and procedures outlined in the DAN Employee Handbook.
Perform additional duties and responsibilities as assigned.


MINIMUM QUALIFICATIONS
Bachelor's degree or a minimum of 5 years of experience in claims, customer service, or a related field
Proficiency in Microsoft Office applications
Strong verbal and written communication skills, including professional phone etiquette
Excellent organizational, time management, and problem-solving abilities with strong attention to detail
Ability to handle sensitive information with confidentiality and professionalism.
Ability to obtain and maintain required insurance licensing (training and associated costs provided by DSI


Work Environment
Hybrid work arrangement is available with this role, 2 days remote and 3 days in office, post the 90-day probationary period.


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