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Claims Expert Jobs (NOW HIRING)

Baptist Health

Manager, Claims Operations

Homewood, AL · On-site

Serves as a regional expert and source of support across a multi-hospital assignment. * Manages assigned claims, with a focus on professional and general liability, but also including property, auto ...

Baptist Health

Manager, Claims Operations

Homewood, AL · On-site

Serves as a regional expert and source of support across a multi-hospital assignment. * Manages assigned claims, with a focus on professional and general liability, but also including property, auto ...

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Technical Consultant Casualty Claims

Howell, MI · Hybrid

Our Claims team is currently seeking a Technical Consultant Casualty Claims. This is a full-time, ... The consultant analyzes complex data, provides expert opinions to support claim resolution, and may ...

EMC Insurance Group, Inc.

Casualty Claims Consultant

$124K - $177K/yr

In this role, you'll act as a key expert guiding complex casualty claims to strong outcomes. You'll partner with claims teams and leadership to shape strategy, provide direction on high-impact cases ...

Great American Insurance Group

Mid-Continent Group is currently seeking a Claims Specialist/Senior Claims Specialist to join our ... Offer expert advice to other members of your team on complex claim file management and demonstrate ...

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Claims Expert information

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$34K

$72.1K

$118.5K

How much do claims expert jobs pay per year?

As of Jun 25, 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 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 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 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.

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.
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 June 2026, with employment types broken down into 97% Full Time, 2% Part Time, and 1% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $72,103 per year, or $34.7 per hour.
Manager, Claims Operations

Manager, Claims Operations

Baptist Health

Homewood, AL • On-site

Full-time

Posted 8 days ago

Baptist Health South Florida rating

7.9

Company rating: 7.9 out of 10

Based on 96 frontline employees who took The Breakroom Quiz

1st of 23 rated health and beauty retailers

Job description

Responsible for providing strategic leadership, oversight, and coordination of claims activities across a multi-hospital region within the health system, with a focus on medical professional and general liability claims. Serves as a key advisor to senior leadership, working collaboratively with clinical, operational, and legal teams to minimize claims exposure. Directs assigned staff and outside legal counsel, ensuring effective claims management. Serves as a source of guidance, support, and oversight to a team of Claims Adjusters.

  • Manages the development, coordination, and continuous improvement of the claims program, including regional strategies for claims handling, ensuring alignment with organizational objectives.
  • Oversees day-to-day operations of the claims program, providing operational leadership and direction to Claims Adjusters across assigned areas, while ensuring accountability and consistency in claims handling.
  • Supports departmental planning and goal execution by aligning claims management activities with organizational priorities and initiatives.
  • Provides operational leadership to enhance claims processing, minimizing loss exposure and contributing to the protection of organizational assets.
  • Analyzes claims data and trends to identify opportunities for risk management, quality, and patient safety improvements.
  • Develops and coordinates claims education programs to further reduce loss exposure.
  • Participates in internal claims team meetings, routine claims strategy meetings, and organizational meetings at regional and corporate levels.
  • Prepares and presents claims activity and initiatives to leadership, insurance underwriters, and organizational committees.
  • Prepares and maintains updated claims reports for leadership review.
  • Demonstrates subject matter expertise in claims handling.
  • Serves as an escalation point for complex claims issues, providing expert guidance and decision-making support to Claims Adjusters.
  • Serves as a regional expert and source of support across a multi-hospital assignment.
  • Manages assigned claims, with a focus on professional and general liability, but also including property, auto, and other lines.
  • Coordinates a complete investigation and evaluation of all assigned claims, providing oversight and direction to Claims Adjusters, and collaborating with claims leadership to develop effective strategy for resolution of each claim.
  • Participates in evaluating, setting, and adjusting reserves, in conjunction with claims leadership.
  • Utilizes claims management and loss reduction techniques in negotiating and settling claims within designated authority.
  • Handles mediations, as assigned by claims leadership and within designated authority.
  • Maintains, evaluates, and oversees management of claim files to ensure detailed documentation of all significant claims’ activity, including substantive communications with legal counsel and insurance contacts, analysis and evaluation of all witnesses, witness testimony, key defensibility issues, and decision-making for each claim.
  • Ensures that a trusting, liaison-type relationship is established between claims team members, outside legal counsel, and involved Baptist Health team members and physicians, from initiation of the claim through resolution.
  • Ensures that a robust claims investigation is completed on each claim, and that all claim activities are properly coordinated with assigned legal counsel, including comprehensive interpretation of medical records, retention of key experts, complete facilitation of discovery, in-depth and thorough research, as needed, and coordination of and attendance at witness interviews and depositions.
  • Fully participates in trial preparation and oversight, including focus groups, witness preparation, and development of trial exhibits.
  • Attends and oversees trial on all assigned claims and reports day-to-day findings and analysis to claims leadership.
  • Manages and oversees licensure investigations involving employed physicians and team members, in conjunction with assigned legal counsel.
  • Reviews all legal billing and claims expenses to ensure compliance with litigation plan and prepares and presents data to assist with departmental budget.
  • Maintains reasonably regular, punctual attendance consistent with Baptist Health policies, the ADA, FMLA and other federal, state and local standards.
  • Maintains compliance with all Baptist Health policies and procedures.

Education/Training
  • Bachelor’s degree in healthcare (preferred), business or closely related field.
Experience
  • Five (5) years of medical-legal or claims adjusting experience.
  • Clinical experience also preferred.

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About Baptist Health South Florida

Sourced by ZipRecruiter

Baptist Health South Florida is the largest healthcare organization in the region, with 12 hospitals, more than 27,000 employees, 4,000 physicians and 100 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. A not-for-profit organization supported by philanthropy and committed to its faith-based charitable mission of medical excellence, Baptist Health has been recognized by Fortune as one of the 100 Best Companies to Work For in America and by Ethisphere as one of the World's Most Ethical Companies.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Miami, FL, US

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