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Complex Claims Director Jobs in Raleigh, NC (NOW HIRING)

Oversight and management of claims and denials management follow-up operations. Analyzes, plans and ... Serves as line of escalation for high priority, complex accounts to be worked, including ...

... complex professional services, engineering, consulting, and field-services environment. Why Join ... claims-related safety metrics. Following an offer, candidates will be required to satisfactorily ...

Litigation Associate

Raleigh, NC · Hybrid

$160K - $225K/yr (+ commission)

Complex Litigation or Insurance Coverage Type: Full-Time (Hybrid) We're partnered with a respected ... You'll work closely with experienced attorneys, gain direct client exposure, and play an active ...

Direct the lifecycle of complex business disputes, evaluating claims and executing comprehensive defense and prosecution strategies. * Legal Writing & Motion Practice: Draft pleadings, administrative ...

Direct First-Chair Track: Gain immediate, hands-on deposition, oral advocacy, and motion practice ... Defend local to international employers across complex state/federal litigation, administrative ...

Showing results 21-40

Complex Claims Director information

See Raleigh, NC salary details

$81.2K

$123.3K

$173K

How much do complex claims director jobs pay per year?

As of Sep 13, 2026, the average yearly pay for complex claims director in Raleigh, NC is $123,337.00, according to ZipRecruiter salary data. Most workers in this role earn between $102,600.00 and $137,100.00 per year, depending on experience, location, and employer.

What is a complex claims director?

Complex Claims Directors are senior insurance professionals responsible for overseeing the management and resolution of intricate insurance claims, often involving large financial exposures, multiple parties, or complex legal issues. They lead a team of claims specialists, coordinate with legal counsel, and ensure that claims are handled efficiently and in compliance with company policies and regulations. Their expertise helps organizations mitigate risk and ensure fair outcomes for all parties involved.

How does a complex claims director typically collaborate with legal teams and other departments during high-stakes claims investigations?

As a Complex Claims Director, collaboration with legal teams and other departments such as underwriting, risk management, and compliance is a central part of the role. Directors often lead cross-functional meetings to share critical case updates, discuss strategies for claim resolution, and ensure all regulatory and contractual requirements are met. Effective communication and coordination are essential, as these cases may involve litigation, negotiations, and extensive documentation. Building strong relationships across departments helps streamline the process and achieve the best possible outcomes for both the client and the organization.

What are the key skills and qualifications needed to thrive as a complex claims director, and why are they important?

To thrive as a Complex Claims Director, you need deep expertise in insurance claims management, strong analytical abilities, and a relevant bachelor's degree or higher, often with industry certifications such as CPCU or AIC. Familiarity with claims management systems, regulatory compliance tools, and advanced reporting software is typically required. Exceptional leadership, negotiation, and decision-making skills help you manage teams and resolve high-stakes claims efficiently. These competencies are crucial for ensuring accurate claim resolution, minimizing risk, and maintaining client trust in complex insurance environments.

What is the difference between Complex Claims Director vs Claims Manager?

AspectComplex Claims DirectorClaims Manager
CredentialsTypically requires a professional insurance certification (e.g., CPCU, ARM) and extensive industry experienceOften requires relevant insurance licenses and several years of claims handling experience
Work EnvironmentStrategic leadership in large insurance companies or third-party administrators, overseeing complex claimsDay-to-day claims processing and team supervision within insurance companies or agencies
Employer & Industry UsageCommonly found in large insurers, TPA firms, and corporate risk managementWidely used across insurance carriers, agencies, and claims departments

The Complex Claims Director focuses on managing and overseeing complex, high-value claims and strategic claims operations, often at a senior level. In contrast, Claims Managers handle daily claims processing, team supervision, and operational tasks. Both roles require industry-specific credentials, but the Director position emphasizes strategic oversight of complex cases.

What job categories do people searching Complex Claims Director jobs in Raleigh, NC look for?

The top searched job categories for Complex Claims Director jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Complex Claims Director jobs?

Cities near Raleigh, NC with the most Complex Claims Director job openings:

Infographic showing various Complex Claims Director job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 91% Full Time, 6% Part Time, and 2% Contract. Highlights an 82% Physical, 4% Hybrid, and 14% Remote job distribution, with an average salary of $123,337 per year, or $59.3 per hour.

Epic Denials Manager

Raleigh, NC • Remote

Deloitte
Finance and Insurance • 10K+ employees

Full-time

Posted 20 days ago


Deloitte rating

8.2

Company rating: 8.2 out of 10

Based on 93 frontline employees who took The Breakroom Quiz


Job description

Epic Denials Manager

Position Summary

Join Deloitte's AI & Engineering practice to support hospital billing operations in a role focused on claim accuracy, timely reimbursement, and revenue cycle performance. As an Epic Denials Manager, you will help deliver back-end revenue cycle management (RCM) services, including denials and claims submission, denials management, payment posting, and credits and refunds, A/R follow-up for health care provider client.

Recruiting for this role ends on 10/01/2026.

Work you'll do

Epic Denials Manager on the AI & Engineering team, you will be responsible for the following areas. Oversight and management of claims and denials management follow-up operations. Analyzes, plans and implements organizational systems and processes, and makes recommendations for improvements in hospital denials, claims submission, and A/R follow-up operations. Leads activities related to operational analysis, financial analysis and process improvement initiatives. Maintains knowledge base of operational SOPs and workflows for relevant functional areas. Manages staff and employee performance, provides feedback, and leads training, education, and performance improvement activities for staff as required. Works closely with Manager of Billing and engagement leadership to resolve barriers to account and claim processing and identify and implement opportunity areas to remediate issues and improve workflows. Serves as line of escalation for high priority, complex accounts to be worked, including interactions with third party payers and client stakeholders as necessary to process accounts and claims. Regularly monitors work queues and workflows in Epic, claims clearinghouse, and other relevant technology systems. Collaborates closely with client managers and directors to ensure continuous open communication about hospital operations that impact delivery of services. Works with client team to develop and implement action plan to address trends as appropriate

Keeps current on insurance regulations, managed care contracts billing regulations, coding and fee schedules. Proactively manages access scorecards including user quality, productivity and team performance compared to Key Performance indicators and Service Level Agreements. This is a remote role with minimal travel requirements. A successful candidate would possess these skills:

  • Ability to work independently and collaborate as part of a team
  • Effective written and verbal communication skills
  • Meticulous attention to detail and quality of work product
  • Ability to build and sustain professional relationships
  • Ability to lead projects or workstreams
  • Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
  • Strong interpersonal skills and professional demeanor
  • Ability to meet deadlines

The team

AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements. Our Industry Solutions offering provides verticalized solutions that transform how clients sell products, deliver services, generate growth, and execute mission-critical operations. We deliver integrated business expertise with scalable, repeatable technology solutions specifically engineered for each sector.

Qualifications

Required:

  • 6+ years of experience as a Manager or Senior in processing and resolving third party payer denials, including technical and clinical denials, for hospital/acute facility services
  • 3+ years experience in denials resolution for both commercial and government payers
  • Experience leading team of 10+ staff to exceed productivity, quality, and service targets
  • Proficient in Epic Resolute Hospital Billing application
  • Proficient in Epic Analytics and Reporting applications (e.g., SlicerDicer)
  • Bachelor's degree, preferably in information technology, business, or healthcare related field; or equivalent experience
  • Limited immigration sponsorship may be available
  • Ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve
  • Role is remote

Preferred:

  • Experience using Microsoft Word, Excel, and PowerPoint
  • Experience supporting clinical or healthcare business operations
  • Experience preparing and delivering technical demonstrations
  • Experience analyzing denials workflows, claim issues, or operational data

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $140,000 to $160,000 with overtime pay possible. 

You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.


Qualifications:

Epic Denials Manager

Position Summary

Join Deloitte's AI & Engineering practice to support hospital billing operations in a role focused on claim accuracy, timely reimbursement, and revenue cycle performance. As an Epic Denials Manager, you will help deliver back-end revenue cycle management (RCM) services, including denials and claims submission, denials management, payment posting, and credits and refunds, A/R follow-up for health care provider client.

Recruiting for this role ends on 10/01/2026.

Work you'll do

Epic Denials Manager on the AI & Engineering team, you will be responsible for the following areas. Oversight and management of claims and denials management follow-up operations. Analyzes, plans and implements organizational systems and processes, and makes recommendations for improvements in hospital denials, claims submission, and A/R follow-up operations. Leads activities related to operational analysis, financial analysis and process improvement initiatives. Maintains knowledge base of operational SOPs and workflows for relevant functional areas. Manages staff and employee performance, provides feedback, and leads training, education, and performance improvement activities for staff as required. Works closely with Manager of Billing and engagement leadership to resolve barriers to account and claim processing and identify and implement opportunity areas to remediate issues and improve workflows. Serves as line of escalation for high priority, complex accounts to be worked, including interactions with third party payers and client stakeholders as necessary to process accounts and claims. Regularly monitors work queues and workflows in Epic, claims clearinghouse, and other relevant technology systems. Collaborates closely with client managers and directors to ensure continuous open communication about hospital operations that impact delivery of services. Works with client team to develop and implement action plan to address trends as appropriate

Keeps current on insurance regulations, managed care contracts billing regulations, coding and fee schedules. Proactively manages access scorecards including user quality, productivity and team performance compared to Key Performance indicators and Service Level Agreements. This is a remote role with minimal travel requirements. A successful candidate would possess these skills:

  • Ability to work independently and collaborate as part of a team
  • Effective written and verbal communication skills
  • Meticulous attention to detail and quality of work product
  • Ability to build and sustain professional relationships
  • Ability to lead projects or workstreams
  • Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
  • Strong interpersonal skills and professional demeanor
  • Ability to meet deadlines

The team

AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements. Our Industry Solutions offering provides verticalized solutions that transform how clients sell products, deliver services, generate growth, and execute mission-critical operations. We deliver integrated business expertise with scalable, repeatable technology solutions specifically engineered for each sector.

Qualifications

Required:

  • 6+ years of experience as a Manager or Senior in processing and resolving third party payer denials, including technical and clinical denials, for hospital/acute facility services
  • 3+ years experience in denials resolution for both commercial and government payers
  • Experience leading team of 10+ staff to exceed productivity, quality, and service targets
  • Proficient in Epic Resolute Hospital Billing application
  • Proficient in Epic Analytics and Reporting applications (e.g., SlicerDicer)
  • Bachelor's degree, preferably in information technology, business, or healthcare related field; or equivalent experience
  • Limited immigration sponsorship may be available
  • Ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve
  • Role is remote

Preferred:

  • Experience using Microsoft Word, Excel, and PowerPoint
  • Experience supporting clinical or healthcare business operations
  • Experience preparing and delivering technical demonstrations
  • Experience analyzing denials workflows, claim issues, or operational data

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $140,000 to $160,000 with overtime pay possible. 

You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.


Education:Bachelor's DegreeEmployment Type:

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