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Claims Executive Jobs in Raleigh, NC (NOW HIRING)

... Executives to provide effective and timely service to clients and brokers through research and resolution of questions or issues with eligibility, claims, customer service or other operational ...

The Principal CSM is accountable for strengthening executive relationships, accelerating solution ... Working knowledge of risk adjustment, CMS requirements, encounters, claims submissions, and related ...

The Principal CSM is accountable for strengthening executive relationships, accelerating solution ... Working knowledge of risk adjustment, CMS requirements, encounters, claims submissions, and related ...

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Claims Executive information

See Raleigh, NC salary details

$13

$20

$27

How much do claims executive jobs pay per hour?

As of Sep 8, 2026, the average hourly pay for claims executive in Raleigh, NC is $20.46, according to ZipRecruiter salary data. Most workers in this role earn between $17.50 and $22.21 per hour, depending on experience, location, and employer.

What does a claims executive do?

A Claims Executive is responsible for managing and processing insurance claims on behalf of clients or an insurance company. Their duties typically include investigating claims, reviewing policy details, assessing liability, negotiating settlements, and ensuring that claims are handled efficiently and in compliance with company policies and legal standards. They act as a liaison between claimants, insurers, and other parties involved to ensure fair and prompt resolution of claims. Strong communication, analytical, and negotiation skills are essential for this role.

What are the key skills and qualifications needed to thrive as a claims executive?

To thrive as a Claims Executive, you need a solid understanding of insurance policies, claims processing, and risk assessment, often supported by a degree in business, finance, or a related field. Familiarity with claims management software, policy administration systems, and relevant industry certifications like CII or AIC are typically required. Strong negotiation, analytical thinking, and effective communication skills help you excel in handling complex claims and client relationships. These skills ensure accurate, efficient claims resolution and maintain trust between clients and the organization.

What are the main challenges a claims executive typically encounters, and how can they effectively address them?

Claims Executives often face the challenge of balancing customer satisfaction with organizational policy, especially when handling complex or disputed claims. They must manage high workloads and tight deadlines, requiring strong organizational and time-management skills. Effective communication and negotiation are crucial for resolving disputes amicably. Staying updated on industry regulations and internal processes also helps Claims Executives make fair and accurate decisions. Building collaborative relationships with underwriters, legal teams, and clients can further streamline claim resolutions.

What is the difference between Claims Executive vs Claims Adjuster?

AspectClaims ExecutiveClaims Adjuster
CredentialsTypically requires a bachelor's degree in insurance, business, or related field; certifications like CPCU are commonOften requires a high school diploma or equivalent; certifications like AIC or CPCU are advantageous
Work EnvironmentOffice-based, client-facing, and administrative roles within insurance companiesField-based or office-based, investigating claims and assessing damages
Employer & Industry UsageUsed in insurance companies, corporate claims departmentsCommonly employed by insurance firms, adjusting claims on-site or remotely

While both Claims Executives and Claims Adjusters work within the insurance industry, Claims Executives typically handle higher-level administrative and strategic tasks, whereas Claims Adjusters focus on investigating and settling individual claims. Understanding these differences helps job seekers identify roles aligned with their skills and career goals.

What are the most commonly searched types of Claims jobs in Raleigh, NC?

The most popular types of Claims jobs in Raleigh, NC are:

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

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

What cities near Raleigh, NC are hiring for Claims Executive jobs?

Cities near Raleigh, NC with the most Claims Executive job openings:

Infographic showing various Claims Executive job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% Internship, 85% Full Time, 10% Part Time, and 4% Contract. Highlights an 84% Physical, 5% Hybrid, and 11% Remote job distribution, with an average salary of $42,561 per year, or $20.5 per hour.

Clinical Liaison-Brain Injury

LEARNING SERVICES CORPORATION

Raleigh, NC

$58K - $78K/yr

Full-time

Re-posted 10 days ago


Job description

Join the excitement of a dynamic company committed to providing exceptional neurological rehabilitation to adults with brain injury! Learning Services, a Collage Rehabilitation Partner, has been a leading provider of post-acute rehabilitation services for adults with brain injury for over 40 years. We are a growing and dynamic organization known for our integrity, clinical excellence, and commitment to both clients and colleagues. 

We are currently seeking a Clinical Liaison to develop new and strengthen existing relationships with key referral sources to support our programs in Raleigh and Creedmoor, North Carolina.

Position Summary

The Clinical Liaison serves as the primary clinical and business development resource for referral partners, patients, families, and internal teams to drive admissions into Collage Rehabilitation Partners' specialized post-acute rehabilitation programs. This position combines advanced clinical expertise with strategic relationship management to facilitate appropriate patient placement while expanding referral partnerships and supporting organizational growth.

The Clinical Liaison functions as a trusted clinical consultant to physicians, hospital leadership, case managers, discharge planners, rehabilitation providers, insurers, attorneys, employers, and other referral partners. Through comprehensive clinical assessment, consultative problem solving, education, and strategic account management, the Clinical Liaison improves access to specialized rehabilitation services while driving sustainable admissions and revenue growth.

Success in this role requires exceptional clinical judgment, strong business development skills, executive-level relationship management, strategic territory planning, and collaboration across National, Regional, and Local account initiatives to advance the organization's strategic growth objectives.

Essential Responsibilities

Clinical Leadership & Admissions

  • Serves as the primary clinical expert throughout the admissions process for referral partners, patients, families, and interdisciplinary treatment teams.
  • Performs comprehensive pre-admission clinical assessments to determine medical appropriateness, rehabilitation potential, funding resources, payer authorization requirements, program fit, and organizational capabilities.
  • Provides expert clinical consultation regarding patient placement, rehabilitation options, funding resources, and level-of-care recommendations.
  • Coordinates communication among referral sources, physicians, families, payers, admissions, operations, and clinical teams to ensure efficient care transitions.
  • Identifies and resolves barriers that may delay admissions including clinical, operational, payer, transportation, equipment, staffing, and financial issues.
  • Maintains frequent communication with referral sources regarding patient status, admission timelines, discharge planning, and ongoing care coordination.
  • Collaborates with interdisciplinary treatment teams to prepare programs for complex admissions, specialized patient needs, staff education, and successful patient outcomes.
  • Supports development of individualized admission strategies for medically and behaviorally complex patients.

Business Development

  • Drives admissions, revenue growth, and market expansion within assigned geographic territory.
  • Develops and executes annual territory business plans including growth objectives, target accounts, educational initiatives, referral strategies, and measurable performance goals.
  • Develops, strengthens, and maintains strategic relationships with physicians, Level I Trauma Centers, acute rehabilitation hospitals, hospitals, skilled nursing facilities, insurers, case managers, employers, attorneys, life care planners, claims professionals, rehabilitation providers, and other referral partners.
  • Identifies new business opportunities through market analysis, networking, referral trends, and strategic relationship development.
  • Supports payer contracting initiatives through clinical expertise and knowledge of reimbursement methodologies.
  • Collaborates with National Accounts, Regional Leadership, and local market teams to ensure coordinated account strategies across shared customers.
  • Represents Collage Rehabilitation Partners as a strategic clinical consultant while promoting exceptional customer service and organizational excellence.

Strategic Account Management

  • Develops and maintains annual strategic account plans for assigned referral partners.
  • Builds comprehensive relationship maps identifying executive sponsors, physician champions, case managers, discharge planners, clinical leaders, claims professionals, and key decision makers.
  • Conducts regular business reviews with referral partners to strengthen relationships, improve service delivery, identify opportunities, and resolve concerns.
  • Identifies account penetration opportunities while expanding relationships across multiple service lines and stakeholders.
  • Coordinates National, Regional, and Local account strategies to maximize organizational growth.

Education & Market Development

  • Designs and delivers clinical education programs, CEU presentations, workshops, and in-service training related to acquired brain injury, post-acute rehabilitation, patient selection, rehabilitation outcomes, funding resources, and Collage Rehabilitation Partners’ specialized programs.
  • Represents the organization at national, regional, and local conferences, association meetings, networking events, educational seminars, and community outreach activities.
  • Serves as a clinical ambassador for the organization through professional presentations and thought leadership.

Territory Management & Market Intelligence

  • Performs ongoing market analysis including referral trends, competitive landscape, demographic changes, healthcare system developments, physician movement, payer changes, and emerging business opportunities.
  • Collects and communicates competitive intelligence to leadership regarding competitors, market conditions, referral activity, reimbursement trends, and strategic opportunities.
  • Maintains accurate documentation of all customer interactions, referral activity, account plans, presentations, opportunities, and admissions within HubSpot CRM.
  • Maintains an accurate sales pipeline, opportunity forecasting, account hierarchy, contact management, and referral intelligence within the organization’s CRM platform.
  • Provides leadership with regular market updates, referral forecasts, customer feedback, and business development recommendations.

Operational Excellence

  • Collaborates with Admissions, Operations, Clinical Leadership, Finance, Contracting, Marketing, and Executive Leadership to improve customer experience and operational efficiency.
  • Ensures exceptional customer service throughout every stage of the referral and admissions process.
  • Supports quality improvement initiatives designed to improve access, referral conversion, admission timelines, and customer satisfaction.
  • Performs additional duties as assigned.

Performance Expectations

Performance may be evaluated through measurable outcomes including:

  • Admissions Growth
  • Revenue Growth
  • Referral Source Development
  • Strategic Account Penetration
  • New Account Acquisition
  • Referral Conversion Rate
  • Pipeline Development
  • Territory Growth
  • Customer Retention
  • Educational Programs Delivered
  • Conference Participation
  • CRM Compliance
  • Forecast Accuracy
  • Customer Satisfaction
  • Cross-functional Collaboration

Education & Experience

  • Bachelor’s degree in a healthcare-related field required.
  • Active professional clinical license required (RN preferred).
  • Minimum five to seven years of progressive healthcare experience in rehabilitation, case management, business development, or related clinical specialty.
  • Knowledge of acquired brain injury, post-acute rehabilitation, neurobehavioral rehabilitation, workers’ compensation, commercial insurance, Medicare, Medicaid, private funding, structured settlements, liens, Department of Defense, Veterans Affairs, and other rehabilitation funding sources.
  • Experience conducting clinical pre-admission assessments preferred.
  • Experience developing strategic healthcare relationships and managing referral networks.
  • Demonstrated experience presenting educational programs and professional presentations.
  • Experience using CRM platforms (HubSpot preferred).
  • Proficiency with Google Workspace and Microsoft Office.

Core Competencies

The successful Clinical Liaison consistently demonstrates:

  • Clinical Judgment
  • Strategic Thinking
  • Relationship Development
  • Consultative Selling
  • Executive Presence
  • Communication Excellence
  • Business Acumen
  • Financial Awareness
  • Territory Management
  • Presentation Skills
  • Negotiation
  • Customer Service Excellence
  • Emotional Intelligence
  • Collaboration
  • Problem Solving
  • Accountability
  • Adaptability


Learning Services is an Equal Opportunity