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Claims Review Jobs in Raleigh, NC (NOW HIRING)

DAN

Claims Director

Durham, NC · On-site

$130K/yr

Review and approve significant coverage determinations, settlement authority, and denial recommendations where applicable. * Develop and implement claims handling strategies, workflows, and best ...

DAN

Claims Director

Durham, NC · Hybrid

Review and approve significant coverage determinations, settlement authority, and denial recommendations where applicable. * Develop and implement claims handling strategies, workflows, and best ...

Divers Alert Network

Claims Director

Durham, NC · On-site

Review and approve significant coverage determinations, settlement authority, and denial recommendations where applicable. * Develop and implement claims handling strategies, workflows, and best ...

Divers Alert Network

Claims Director

Durham, NC · On-site

Review and approve significant coverage determinations, settlement authority, and denial recommendations where applicable. * Develop and implement claims handling strategies, workflows, and best ...

Erie Insurance

Claims Facilitator

Raleigh, NC · On-site

$40K - $64K/yr

Reviews all pending claims/activities on a regular basis. * Provides support for property claims during periods of heavy volume. The first six duties listed are the functions identified as essential ...

Erie Insurance

Claims Facilitator

Raleigh, NC · On-site

$40K - $64K/yr

Reviews all pending claims/activities on a regular basis. * Provides support for property claims during periods of heavy volume. The first six duties listed are the functions identified as essential ...

Erie Insurance

Claims Facilitator

Raleigh, NC · On-site

$40K - $64K/yr

Reviews all pending claims/activities on a regular basis. * Provides support for property claims during periods of heavy volume. The first six duties listed are the functions identified as essential ...

Erie Insurance

Claims Facilitator

Cary, NC · On-site

$40K - $64K/yr

Reviews all pending claims/activities on a regular basis. * Provides support for property claims during periods of heavy volume. The first six duties listed are the functions identified as essential ...

Erie Insurance

Claims Facilitator

Cary, NC · On-site

$40K - $64K/yr

Reviews all pending claims/activities on a regular basis. * Provides support for property claims during periods of heavy volume. The first six duties listed are the functions identified as essential ...

Erie Insurance

Claims Facilitator

Raleigh, NC · On-site

$40K - $64K/yr

Reviews all pending claims/activities on a regular basis. * Provides support for property claims during periods of heavy volume. The first six duties listed are the functions identified as essential ...

Sedgwick

Claims Representative, Auto

Raleigh, NC · On-site

$50K - $55K/yr

Ability to review and assess Property Damage estimates, total loss evaluations, and related expenses to effectively negotiate first and third party claims. * Knowledge of total loss processing, State ...

Elevance Health

Claims Representative I

Durham, NC · On-site

$16.23 - $24.36/hr

Work is reviewed for technical accuracy and soundness. * Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made. * Researches and analyzes ...

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All JobsClaims Review JobsClaims Review Jobs in Raleigh, NC

Claims Review information

See Raleigh, NC salary details

$38.9K

$59.9K

$89.4K

How much do claims review jobs pay per year?

As of Aug 7, 2026, the average yearly pay for claims review in Raleigh, NC is $59,880.00, according to ZipRecruiter salary data. Most workers in this role earn between $52,500.00 and $63,700.00 per year, depending on experience, location, and employer.

What does a claims review do?

A claims review involves examining insurance claims to verify their accuracy, completeness, and compliance with policy terms. Claims reviewers assess documentation, determine claim validity, and identify potential errors or fraud, often using specialized software and industry knowledge. This process helps ensure proper claim processing and cost control for insurance companies.

Is claims review processing a stressful job?

Claims review is a detail-oriented role that can be stressful due to tight deadlines, high accuracy requirements, and the need to interpret complex policies. It often involves managing large volumes of claims and making critical decisions, which can contribute to job stress, especially during busy periods or when handling difficult cases.

What is the difference between Claims Review vs Claims Adjuster?

AspectClaims ReviewClaims Adjuster
CredentialsTypically requires insurance or claims processing certificationsRequires similar certifications, often with licensing depending on state
Work EnvironmentMostly office-based, reviewing claims electronically or on paperField and office-based, inspecting damages and interviewing claimants
Employer & IndustryInsurance companies, third-party administratorsInsurance companies, public adjusters, third-party administrators
Search & Comparison IntentOften compared for claims processing rolesRelated but involves more investigation and assessment

Claims Review specialists focus on evaluating insurance claims for accuracy and completeness, primarily working in an office setting. Claims Adjusters, on the other hand, investigate claims, assess damages, and determine payouts, often working in the field. Both roles require similar certifications and are integral to the insurance industry, but they differ in responsibilities and work environment.

Do you need a degree to be a claims review?

A degree is not always required to become a claims reviewer, but many employers prefer candidates with a high school diploma or equivalent. Relevant skills include attention to detail, knowledge of insurance policies, and experience with claims processing software; some roles may offer on-the-job training or certification programs.
What cities near Raleigh, NC are hiring for Claims Review jobs? Cities near Raleigh, NC with the most Claims Review job openings:
Claims Review jobs near you
Infographic showing various Claims Review job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $59,880 per year, or $28.8 per hour.

Claims Director

DAN

Durham, NC • On-site

$130K/yr

Full-time

Posted 23 days ago

Job description

TITLE: Director, Claims
FLSA: Exempt, Full Time
DEPARTMENT: Claims
WORKSITE: 6 West Colony Place, Durham, NC
REPORTS TO: EVP, Insurance Operations
OCCUPATIONALSUMMARY:
Responsible for the strategic leadership, operational management, and oversight of the organization's claims department. This role ensures timely, accurate, and compliant claims handling while promoting exceptional customer service, effective risk management, and continuous operational improvement. The Director of Claims leads claims staff, develops departmental processes and performance standards, manages complex and escalated claims matters, and collaborates with internal and external stakeholders to support organizational objectives.
DUTIES/RESPONSIBILITIES:
  • Lead and inspire a service-focused team.
  • Oversee the intake, investigation, evaluation, reserving, and resolution of claims.
  • Ensure claims are handled in accordance with policy provisions, company guidelines, regulatory requirements, and industry standards.
  • Manage complex, high exposure, litigated, or escalated claims
  • Review and approve significant coverage determinations, settlement authority, and denial recommendations where applicable.
  • Develop and implement claims handling strategies, workflows, and best practices.
  • Establish department goals, KPIs, and performance standards.
  • Oversee quality assurance and audit processes for claims handling activities.
  • Identify operational, legal, and financial risks within the claims process and implement corrective actions.
  • Assist in the development and implementation of reservation of rights letters, coverage position letters, and claims procedures.
  • Monitor claim reserves, loss trends, and financial exposure.
  • Assist with budgeting and forecasting related to claims operations.
  • Ensure appropriate expense management and vendor performance standards.
  • Maintain positive relationships with insureds, brokers, members, partners, and external stakeholders.
  • Collaborate cross-functionally with underwriting, operations, finance, and customer service teams.
  • Provide claims reporting and operational updates to executive leadership.
  • Other duties as assigned.

EDUCATION
  • Bachelor's degree or equivalent experience required
  • 10+ years of relevant claims experience
  • 2+ years leadership within a claims management role
  • Valid adjusters license or ability to obtain such

REQUIRED KNOWLEDGE, SKILLS & ABILITIES
  • Knowledge of the scuba diving industry
  • Deep knowledge and experience with captive insurance companies, risk retention groups, accident and health and trip/travel programs
  • Knowledge of Trip/Travel Insurance
  • Excellent interpersonal communication, organization, and management skills
  • Superior project management skills with proven ability to plan, lead and track projects from concept through implementation
  • Ability to manage timelines and milestones to ensure timely reporting and closures
  • Self-motivated with strong attention to details and problem-solving skills
  • Proficient with Microsoft Office Suite and experienced or adaptable to claims management platforms

Hybrid work arrangement is available with this role, 2 days remote and 3 days in office, post the 90-day probationary period.

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