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Claims Expert Jobs (NOW HIRING)

AIG

Claim Analyst IV, Lex Pro

Jersey City, NJ

$85K - $104K/yr

You will communicate regularly with internal and external stakeholders in your role as an Employment Practices and Management Liability claims expert and thought leader. * As a valued member of the ...

AIG

Claim Analyst IV, Lex Pro

Boston, MA

$85K - $104K/yr

You will communicate regularly with internal and external stakeholders in your role as an Employment Practices and Management Liability claims expert and thought leader. * As a valued member of the ...

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$34K

$72.1K

$118.5K

How much do claims expert jobs pay per year?

As of May 31, 2026, the average yearly pay for claims expert in the United States is $72,103.00, according to ZipRecruiter salary data. Most workers in this role earn between $50,000.00 and $89,000.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Claims Expert, and why are they important?

To thrive as a Claims Expert, you need strong analytical skills, deep knowledge of insurance policies, and experience in claims processing, often backed by a bachelor's degree in a relevant field. Familiarity with claims management systems, insurance software, and sometimes industry certifications such as AIC or CPCU is highly valuable. Attention to detail, problem-solving abilities, and effective communication help Claims Experts resolve disputes and negotiate settlements efficiently. These skills ensure accurate claim evaluations, timely resolutions, and high customer satisfaction in a complex regulatory environment.

What are some common challenges a Claims Expert faces when handling complex insurance claims?

Claims Experts often encounter challenges such as interpreting ambiguous policy language, managing high workloads, and dealing with emotionally charged claimants. They must balance the need for thorough investigation with delivering timely resolutions, all while adhering to regulatory requirements and company policies. Effective communication and negotiation skills are essential, as Claims Experts frequently collaborate with legal, medical, and technical professionals to resolve disputes and ensure fair settlements.

What are Claims Experts?

Claims Experts are professionals who assess, investigate, and manage insurance claims to determine their validity and ensure fair settlements. They review documents, interview claimants and witnesses, and work with other parties such as adjusters, lawyers, and medical professionals. Claims Experts may specialize in different types of insurance, such as health, auto, property, or liability. Their goal is to resolve claims efficiently while minimizing risk for the insurance company and ensuring policyholders receive appropriate compensation.

What is the difference between Claims Expert vs Claims Adjuster?

AspectClaims ExpertClaims Adjuster
Required CredentialsCertifications like CPCU, ARM, or state licensesSimilar certifications, often including state licensing
Work EnvironmentOffice-based, client consultations, policy analysisFieldwork, inspecting damages, interviewing claimants
Employer & Industry UsageInsurance companies, brokers, risk management firmsInsurance companies, third-party administrators
Comparison Search IntentUnderstanding roles, career paths, qualificationsAssessing claims, damage evaluation, settlement process

Both Claims Experts and Claims Adjusters work within the insurance industry and often share similar certifications and work environments. However, Claims Experts typically focus on policy analysis and consulting, while Claims Adjusters are more involved in inspecting damages and settling claims. Understanding these differences can help job seekers and employers clarify role expectations and career development paths.

More about Claims Expert jobs
What job categories do people searching Claims Expert jobs look for? The top searched job categories for Claims Expert jobs are:
Infographic showing various Claims Expert job openings in the United States as of May 2026, with employment types broken down into 1% Locum Tenens, 2% As Needed, 88% Full Time, 6% Part Time, 2% Contract, and 1% Nights. Highlights an 85% Physical, 4% Hybrid, and 11% Remote job distribution, with an average salary of $72,103 per year, or $34.7 per hour.

Director, Claims Counsel

Metlife Legal Plans

Cleveland, OH • On-site

$130K - $165K/yr

Full-time

Posted 10 days ago

Job description

Job Title: Director, Claims Counsel

Department: Claims Management

Work Location: Remote

Reports To: VP of Customer Experience

Classification: Exempt

A day in the life of MetLife Legal Plans’ Director, Claims Counsel:

The Director, Claims Counsel is a senior leader within MetLife Legal Plans, responsible for overseeing the review, approval, and resolution of claims, billing inquiries, out-of-network claims matters, and appeals. This role ensures claims are handled accurately, consistently, and in compliance with departmental service level agreements (SLAs), regulatory requirements, and company standards.

In addition to serving as the legal authority for complex and high‑value claims, the Director, Claims Counsel leads and develops a team of 3–4 professionals and partners closely with internal stakeholders to drive quality outcomes, operational efficiency, and continuous improvement across the claim’s organization.


Key Responsibilities

Claims Review & Oversight

  • Review, adjudicate, and approve complex and high‑value claims, including approvals, rejections, and adjustments, in accordance with approved fee schedules and coverage determinations
    • Primary focus on negotiated arrangements, pre‑approved fee schedules, and escalated matters
  • Provide second‑level approvals for claims reviewed by team members
  • Maintain ultimate accountability for claims decisions made by direct reports
  • Ensure all claims are processed and approved within established payment schedules and SLAs
  • Review billing inquiries (“kicks”) to determine appropriate payment actions and whether additional documentation is required from attorneys
  • Identify billing trends, issues, or concerns with network providers and escalate or collaborate with Panel Management as appropriate

Out of network claims& Appeals Leadership

  • Oversee the review of out-of-network claims to ensure accuracy, compliance, and timely payment, requesting additional information from members when necessary
  • Provide legal guidance to the Claims Team on matters involving legal interpretation, coverage, or complex reimbursement issues
  • Advise and support the Claims Team in responding to member inquiries and resolving escalated out of network claims concerns
  • Review and respond to out-of-network claims and coverage/claims appeals in compliance with company SLAs and regulatory requirements

Leadership & People Management

  • Lead, coach, and develop a team of 3–4 individuals, fostering a culture of accountability, ownership, empowerment, and continuous learning
  • Conduct regular 1:1 meetings, performance reviews, and development planning to support individual and team growth
  • Serve as a trusted claims and legal subject‑matter expert for internal partners and senior stakeholders

Systems, Process & Audit Support

  • Support claims systems and application management, including:
    • Participation in User Acceptance Testing (UAT)
    • Defining and documenting business and feature requirements for system enhancements
    • Identifying, documenting, and reporting system issues, including performance trends and business impact
  • Support internal and external claims audit activities, ensuring documentation, processes, and outcomes meet audit and compliance standards

Additional Responsibilities

  • Address coverage and claims appeals and escalations
  • Serve as a coverage expert for MLP
  • Provide training/education sessions on legal coverage and claims processing for Claims and Panel Organization
  • Partner cross‑functionally to improve claims processes, controls, and member experience
  • Perform other duties as assigned


Ideal Qualifications

  • Bachelor’s degree from an accredited university
  • Property & Casualty licensing preferred
    • Candidates without active licenses must be willing to obtain them
  • J.D. from an accredited law school with 4+ years of experience as a practicing attorney (preferred)
  • 5+ years of experience in claims administration, fee reimbursement, billing inquiries, or related work
  • Demonstrated leadership experience with the ability to build high‑performing teams and lead with clarity and accountability
  • Strong expertise in claims review, adjudication, and approval processes
  • Proven ability to analyze and interpret complex fee, legal, and coverage issues
  • Strong communication skills with the ability to engage effectively with attorneys, members, and internal stakeholders on sensitive matters
  • High degree of professionalism, discretion, and confidentiality
  • Strong organizational and time‑management skills with the ability to manage competing priorities in a high‑volume environment
  • Proficiency with Microsoft Office tools, including Teams, Excel, Outlook, and PowerPoint
  • Positive, adaptable, and solutions‑oriented leadership style


What Will Make You Stand Out

  • Broad legal experience across general practice and litigation matters
  • Prior experience leading or managing a team in a claims or legal environment
  • 7+ years of experience with claims, fee reimbursements, and billing inquiries
  • Active licensure as a Claims Adjuster

Travel

This position requires up to 5% travel.


Note: This job description in no way states or implies that these are the only duties to be performed by the associate in this position. Associates will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbent will possess the skills, aptitude and ability to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at-will” relationship.

MetLife Legal Plans is an Equal Opportunity Employer. All employment decisions are made without regards to race, color, national origin, religion, creed, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, marital or domestic/civil partnership status, genetic information, citizenship status (although applicants and employees must be legally authorized to work in the United States), uniformed service member or veteran status, or any other characteristic protected by applicable federal, state, or local law (“protected characteristics”).

If you need an accommodation due to a disability, please email us at mlprecruiting@legalplans.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process.