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Claims Operations Jobs (NOW HIRING)

Imedica

Director, Claims Operations

Minnetonka, MN · On-site

$113K - $194K/yr

The Director, Claims Operations oversees end-to-end claims functions, including claims processing, payment recovery, claim analysis and issue resolution, and provider appeals. A skilled people and ...

Medica

Director, Claims Operations

Minnetonka, MN · On-site

$113K - $194K/yr

The Director, Claims Operations oversees end-to-end claims functions, including claims processing, payment recovery, claim analysis and issue resolution, and provider appeals. A skilled people and ...

Imedica

Director, Claims Operations

Madison, WI

$113K - $194K/yr

The Director, Claims Operations oversees end-to-end claims functions, including claims processing, payment recovery, claim analysis and issue resolution, and provider appeals. A skilled people and ...

Coalition, Inc.

Claims Operations Specialist

WV · On-site +1

$100K/yr

About the role The Claims Operation Specialist plays a critical role in managing our claims reporting operations. This position is responsible for the overall claims reporting process to our carrier ...

Fortegra

Claims Operations Manager

Jacksonville, FL · On-site

The Claims Operations Manager is a key leader, coach, and escalation point for a fast-moving claims support team. This role connects day-to-day claims operations with broader functional needs ...

QBE

Specialist, Claims Operations

Peachtree City, GA · Hybrid

$76K/yr

Employee Specialist, Claims Operations * Location: USA -Marblehead, MA and Atlanta, GA * Work Arrangement: Hybrid * The salary range for this role is:$76,000-125,500K The Opportunity The role ...

QBE

Specialist, Claims Operations

Marblehead, MA · Hybrid

$76K/yr

Employee Specialist, Claims Operations * Location: USA -Marblehead, MA and Atlanta, GA * Work Arrangement: Hybrid * The salary range for this role is:$76,000-125,500K The Opportunity The role ...

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Claims Operations information

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$12

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$43

How much do claims operations jobs pay per hour?

As of Jul 7, 2026, the average hourly pay for claims operations in the United States is $23.50, according to ZipRecruiter salary data. Most workers in this role earn between $17.55 and $25.72 per hour, depending on experience, location, and employer.

What are some common challenges faced in a Claims Operations role and how can they be managed?

Professionals in Claims Operations often encounter challenges such as managing high volumes of claims, ensuring accuracy under tight deadlines, and navigating complex regulatory requirements. To manage these effectively, strong organizational skills, attention to detail, and familiarity with claims processing software are essential. Many teams use workflow automation and regular training sessions to stay updated on procedures and compliance standards, which helps streamline operations and reduce errors. Building strong communication skills also aids in collaborating with adjusters, underwriters, and customers to resolve issues efficiently.

What is the difference between Claims Operations vs Claims Adjuster?

AspectClaims OperationsClaims Adjuster
Primary RoleOversees claims processing, manages teams, and ensures compliance across claims functions.Evaluates individual claims, investigates damages, and determines settlement amounts.
Required CredentialsTypically requires claims handling certifications, insurance licenses, and management experience.Requires adjuster licenses, claims handling certifications, and knowledge of insurance policies.
Work EnvironmentOffice-based, team management, and coordination with various departments.Fieldwork and office work, direct interaction with claimants and vendors.
Industry UsageCommonly used in insurance companies for claims processing departments.Used by insurance carriers for claim evaluation and settlement.

Claims Operations focuses on managing the overall claims process and team coordination, while Claims Adjusters handle individual claim evaluations and settlements. Both roles require insurance-related certifications and are integral to the insurance industry, but they differ in scope and daily responsibilities.

What are Claims Operations?

Claims Operations refers to the processes and teams responsible for handling, processing, and managing insurance claims from start to finish. This includes reviewing claims submissions, verifying information, coordinating investigations, and ensuring that claims are settled efficiently and accurately. Claims Operations professionals work to streamline workflows, comply with regulations, and deliver a positive experience for policyholders. Their role is essential in preventing fraud, reducing costs, and maintaining customer satisfaction within an insurance company.

What are the key skills and qualifications needed to thrive in Claims Operations, and why are they important?

To thrive in Claims Operations, you need strong analytical abilities, attention to detail, and a background in insurance, finance, or a related field. Familiarity with claims management systems, regulatory compliance tools, and industry certifications such as AIC (Associate in Claims) is often required. Excellent communication, problem-solving skills, and adaptability help professionals handle complex claims and interact effectively with clients and stakeholders. These competencies are crucial for ensuring accurate, timely claims processing and maintaining customer satisfaction.
More about Claims Operations jobs
What are the most commonly searched types of Claims Operations jobs? The most popular types of Claims Operations jobs are:
What states have the most Claims Operations jobs? States with the most job openings for Claims Operations jobs include:
What job categories do people searching Claims Operations jobs look for? The top searched job categories for Claims Operations jobs are:
Claims Operations jobs near you
Infographic showing various Claims Operations job openings in the United States as of July 2026, with employment types broken down into 91% Full Time, 7% Part Time, and 2% Contract. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $48,885 per year, or $23.5 per hour.
Claims Operations Director

Claims Operations Director

Capital Health Plan

Tallahassee, FL • On-site

Full-time

Posted 16 days ago

Job description

Location: Tallahassee, FL

Department: Claims

FLSA: Exempt

Schedule: As required


About the role:

We are seeking a Claims Operations Director to lead and oversee Capital Health Plan's end‑to‑end claims operations, including claims processing, other party liability (OPL) recoveries, premium billing and reconciliation, contract administration, and payment integrity functions.

This role directs multiple operational teams and managers, ensuring the timely, accurate, and compliant processing of claims and premiums while maintaining the integrity of provider records, contract configurations, and reimbursement systems. The Claims Operations Director partners closely with senior leadership, cross‑functional teams, and third‑party vendors to drive operational performance, regulatory compliance, system enhancements, and continuous improvement across all claims‑related functions.


We're looking for someone who has:

  • Bachelor's degree from an accredited four-year college or university, or equivalent education and experience
  • Significant leadership experience in claims operations, healthcare administration, or related functions; ten years of related experience preferred
  • Demonstrated experience managing multi-disciplinary operational teams within a healthcare or payer environment
  • Strong working knowledge of claims administration, premium billing, contract configuration, and payment integrity processes
  • Ability to develop workflows, productivity standards, and performance metrics to meet operational and regulatory goals
  • Strong analytical skills with experience using data to set KPIs and support senior leadership reporting
  • Thorough understanding of healthcare billing and coding concepts (e.g., CPT, ICD, revenue codes)
  • Strong written and verbal communication skills, including the ability to present complex operational information to senior leadership

Highly preferred candidates also have:

  • Experience overseeing Medicare reimbursement processes and adapting to regulatory changes
  • Experience with provider contract administration and system configuration management
  • Experience managing software enhancements, reimbursement systems, or claims adjudication platforms
  • Familiarity with provider billing operations and dispute resolution processes
  • Strong financial acumen, including basic accounting knowledge and reconciliation concepts
  • Experience leading cross-functional initiatives to improve claims, billing, or payment integrity outcomes

About Capital Health Plan (CHP):

CHP is a locally based, not‑for‑profit health maintenance organization serving the Tallahassee region for more than four decades. Founded by community leaders with a mission to deliver high‑quality, affordable, and patient‑centered health care, CHP has grown into a nationally recognized healthcare organization while remaining deeply rooted in the communities it serves.


CHP is proud to be an Equal Opportunity Employer and is committed to maintaining a workplace that values professionalism, integrity, and respect. We provide equal employment opportunities to all employees and applicants and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status.


Job Posted by ApplicantPro
Capital Health Plan logo

About Capital Health Plan

Sourced by ZipRecruiter

In 1982, a group of Tallahassee’s civic leaders came together to create a quality, affordable health care system to meet the health needs of the community. Forty years later, Capital Health Plan has become a national health care leader. We started with 5,000 members and a network of 75 doctors. We’ve now grown to more than 135,000 members with a broad network of more doctors, hospitals and other health care providers throughout our service area. A key component of CHP’s delivery system is its employed medical staff, who practice in three state-of-the-art health centers CHP has developed to serve its membership. These health centers are equipped with electronic medical records and can accommodate a broad range of preventive, primary, and specialty care services including evening and weekend urgent care, lab, x-ray, digital mammography, ultrasound, colon screening, eye care services, wound care, and a center focused on the needs of chronically ill members. CHP’s ability to offer this highly organized component of its delivery system provides unique opportunities for adding value. The staff model of CHP’s delivery system is the engine of our program, consistently driving better results on measures of clinical care, member satisfaction, and affordability. As a not-for-profit HMO, we exist to improve the health of our communities by providing high quality, comprehensive health plans with low administrative costs, through primary care focused, patient-centered healthcare.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Tallahassee, FL, US

Year founded

1982

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