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Claims Processor Jobs in Raleigh, NC (NOW HIRING)

Aston Carter

Claims Manager

Raleigh, NC · On-site

$100K - $150K/yr

Work closely with insurance carriers and adjusters to facilitate efficient claims processing and resolution. * Track claim status, follow up proactively on open items, and help prevent claims from ...

Aston Carter

Claims Manager

Raleigh, NC · On-site

$100K - $150K/yr

Work closely with insurance carriers and adjusters to facilitate efficient claims processing and resolution. * Track claim status, follow up proactively on open items, and help prevent claims from ...

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How much do claims processor jobs pay per hour?

As of Jun 5, 2026, the average hourly pay for claims processor in Raleigh, NC is $18.63, according to ZipRecruiter salary data. Most workers in this role earn between $15.87 and $20.10 per hour, depending on experience, location, and employer.

What Is a Claims Processor?

A claims processor reviews insurance claims. Their responsibilities include verifying insurance policy coverage and making sure client information is accurate. After they determine there is a covered loss, a processor documents the information and makes sure all the required paperwork is complete. Other duties include modifying new or existing policies.

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

To thrive as a Claims Processor, you need strong analytical abilities, attention to detail, and knowledge of insurance policies, typically supported by a high school diploma or associate degree. Familiarity with claims management software, data entry systems, and sometimes industry certifications like AIC (Associate in Claims) is valuable. Excellent organization, communication, and customer service skills help you efficiently resolve claims and interact with clients. These competencies ensure accuracy, minimize errors, and maintain trust in the claims process.

What are some common challenges faced by Claims Processors, and how can they be managed effectively?

Claims Processors often encounter challenges such as managing high volumes of claims, handling complex or incomplete documentation, and meeting strict accuracy and timeliness standards. To navigate these, strong organizational skills, effective communication with colleagues and claimants, and attention to detail are crucial. Utilizing workflow management tools and maintaining open channels with supervisors and other departments can help address issues quickly and ensure claims are processed efficiently. Regular training and staying updated on policy changes also support success in this role.

What does a Claims Processor do?

A Claims Processor is responsible for reviewing, evaluating, and processing insurance claims submitted by policyholders. They verify the accuracy of the information provided, ensure all required documentation is present, and determine if the claim meets the policy's terms and conditions. Claims Processors work with both customers and insurance adjusters to resolve any discrepancies and help facilitate timely payments. Their role is essential in ensuring that claims are handled efficiently and fairly.

What is the qualification for claims processor?

A claims processor typically needs a high school diploma or equivalent, strong attention to detail, good organizational skills, and familiarity with claims processing software. Some employers may prefer candidates with prior experience in insurance or customer service, and certifications such as the Certified Claims Professional (CCP) can be advantageous.

What is the difference between Claims Processor vs Claims Examiner?

AspectClaims ProcessorClaims Examiner
Required CredentialsHigh school diploma or equivalent; some roles may require certificationHigh school diploma; certification often preferred
Work EnvironmentOffice setting, processing claims efficientlyOffice setting, reviewing and approving claims
Employer & Industry UsageInsurance companies, healthcare providersInsurance companies, government agencies
Common Search & ComparisonClaims Processor vs Claims Examiner

Claims Processors primarily handle the data entry and initial processing of insurance claims, focusing on accuracy and efficiency. Claims Examiners review claims for validity, compliance, and coverage before approval. While both roles work within the insurance industry and require similar credentials, Claims Examiners typically perform more detailed reviews and decision-making tasks. Understanding these differences helps job seekers identify the right role based on their skills and career goals.

More about Claims Processor jobs
What are the most commonly searched types of Claims Processor jobs in Raleigh, NC? The most popular types of Claims Processor jobs in Raleigh, NC are:
What are popular job titles related to Claims Processor jobs in Raleigh, NC? For Claims Processor jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Claims Processor jobs in Raleigh, NC look for? The top searched job categories for Claims Processor jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Claims Processor jobs? Cities near Raleigh, NC with the most Claims Processor job openings:
Claims Processor jobs near you
Director of Claims

Director of Claims

Blue Cross and Blue Shield of North Carolina

Chapel Hill, NC • Hybrid

$143K - $229K/yr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 6 days ago

Blue Cross and Blue Shield of North Carolina rating

7.8

Company rating: 7.8 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

164th of 260 rated insurance

Job description

Job Description

The Director of Claims leads the organization responsible for the accurate, timely processing and payment of claims. This role oversees the execution of claims strategy by setting a clear business agenda that drives high performance while effectively managing costs. The Director advances the department's strategic priorities and ensures the delivery of customercentric solutions that support enterprise performance goals. The role is responsible for optimizing resources through effective deployment, crosstraining, and talent development to strengthen inventory management and operational flexibility. In addition, the Director evaluates operational performance by establishing performance targets across provider and customer segments and holding teams accountable for achieving business outcomes.

WhatYou'llDo

  • Set team priorities that align with the organization's core values, strategic objectives, and key deliverables
  • Direct endtoend claims processing, adjustments, and financial recovery activities across commercial, government, and interplan lines of business, leveraging datadriven analytics to inform decisions and execution
  • Partner with operational leads and workforce management to supplement strategy with the development of budgets, staffing models, and operational performance standards
  • Lead claims process standardization and automation initiatives in partnership with the Continuous Improvement function
  • Collaborate with the Business Advisory team to identify and deliver claims process improvements, including Lean Six Sigma initiatives
  • Approve business and technical requirements, oversee initiatives, and prioritize decisions to effectively address evolving business needs
  • Partner with the Vendor Management Lead to identify and capture value through alternative staffing models and vendor solutions
  • Collaborate with providers and people leaders to develop and implement tailored customer strategies that improve performance and outcomes
  • Develop, coach, and motivate leaders and team members to reinforce core values and advance the target operating model
  • Leverage and advance analytical capabilities to support strategy execution and operational performance management
  • Resolve complex escalations and contribute to training development to maintain and improve service delivery
  • End to end inventory management to align with all regulatory, Internal, external and other applicable processing guidelines and timeliness expectations; includes evaluating and adjusting all processing guidelines as required to meet customer expectations
  • Report operational updates to the Claims AVP and Health Plan Operations VP; serve as a subject matter expert for Claims Operations

What You Bring

  • Bachelor's degree or advanced degree (where required)
  • 10+ years' experience in Health Care Delivery and Operations
  • In lieu of degree, 12+ years of experience in related field.
  • Deep health plan claims and service expertise
  • 5+ years of progressive leadership experience

Bonus Points

  • Strong analytical skills with the ability to drive transformational, consumer centric change while managing operations - highly preferred
  • Six Sigma/Continuous improvement experience - highly preferred

WhatYou'llGet

  • The opportunity to work at thecutting edgeof health care delivery with a teamthat'sdeeply invested in the community
  • Work-life balance, flexibility, and the autonomy to dogreat work
  • Medical, dental, and vision coverage along withnumeroushealth and wellness programs
  • Parental leave and support plus adoption and surrogacyassistance
  • Career development programs and tuition reimbursement for continued education
  • 401k match including an annual company contribution
  • Learn more

#LI-Hybrid

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$143,616.00 - $229,786.00

Skills

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JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.

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