ZipRecruiter

Log In

1

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

ASK Consulting

Appeals Analyst

Durham, NC · On-site

... complex issues while ensuring responses comply with applicable regulatory, accreditation, and ... Directors and internal teams on clinical appeals and grievances. • Conduct outreach to providers ...

Actalent

Pharmacy Technician (Certified/registered)

Cary, NC · On-site

$18.25 - $22.50/hr

... complex therapy access needs. * Experience using pharmacy management systems to process claims and ... without direct face-to-face patient contact, as all interactions occur via phone and digital ...

Actalent

Pharmacy Technician (Certified/registered)

Cary, NC · On-site

$17.75 - $21.50/hr

... complex therapy access needs. * Experience using pharmacy management systems to process claims and ... without direct face-to-face patient contact, as all interactions occur via phone and digital ...

Duke University

Risk Manager

Durham, NC · On-site

Negotiate resolution with the authority from the Director. Provide basic and complex preventive ... Investigate, evaluate and document pre-litigation occurrences and claims. Recommend resolution, and ...

Socket.dev

CHIEF FINANCIAL OFFICER

Raleigh, NC · On-site

$185K - $200K/yr

ASNC operates a complex, diversified financial model with approximately $34 million in annual ... Direct claims denial management, appeals processes, and resolution of billing discrepancies.

True North Group LLC.

Direct Sales Leader

Knightdale, NC · On-site

$90K - $110K/yr

You can explain complex ideas simply, both one-on-one and to a group. Organized and Reliable: You ... Helping both your clients and those of your team navigate claims, renewals, and benefit questions.

Autismsociety Nc

CHIEF FINANCIAL OFFICER

Raleigh, NC · On-site

$185K - $200K/yr

ASNC operates a complex, diversified financial model with approximately $34 million in annual ... Direct claims denial management, appeals processes, and resolution of billing discrepancies.

previous page

Showing results 41-60

All JobsComplex Claims JobsComplex Claims Director JobsComplex Claims Director Jobs in Raleigh, NC

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 15, 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 are popular job titles related to Complex Claims Director jobs in Raleigh, NC?

For Complex Claims Director jobs in Raleigh, NC, the most frequently searched job titles are:

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:

Complex Claims Director jobs near you
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.

Appeals Analyst

Durham, NC • On-site

ASK Consulting
See more jobs at ASK Consultingexternal

Full-time

Medical

Posted 5 days ago

Job description

Description
Job Title
Appeals Analyst
Position Description
We are seeking an experienced Appeals Analyst to join the Grievances and Appeals team. The individual will be responsible for researching, analyzing, resolving, and responding to confidential and sensitive appeals, grievances, coding disputes, and coverage/organization determinations. The ideal candidate will have experience in Medicare and health insurance, strong case management and time-management skills, and the ability to independently research complex issues while ensuring responses comply with applicable regulatory, accreditation, and organizational guidelines.
Roles Responsibilities
• Research, analyze, and resolve member and provider grievances, appeals, coding disputes, and coverage/organization determinations.
• Review cases received from members, member representatives, providers, internal teams, senior leadership, regulatory agencies, and other stakeholders.
• Analyze and interpret health plan benefits, policies, procedures, medical terminology, coding, and related functions.
• Independently evaluate cases and make appropriate decisions based on established policies and guidelines.
• Prepare comprehensive appeal and grievance response letters that clearly communicate findings and decisions.
• Prepare case files and position statements for external reviews conducted by independent review organizations, benefit panels, and external medical consultants.
• Conduct detailed investigations and accurately document findings, actions, and case outcomes in applicable systems.
• Monitor daily reports to ensure cases are completed within required service timelines.
• Prioritize and manage a fluctuating caseload while maintaining quality, accuracy, and productivity.
• Gather relevant clinical information using established criteria and corporate medical policies.
• Collaborate with Medical Directors and internal teams on clinical appeals and grievances.
• Conduct outreach to providers and internal departments when additional information or clarification is required.
• Ensure all work complies with applicable state and federal requirements, accreditation standards, and organizational policies.
• Maintain timely, accurate, and efficient case processing.
Skills
• 3-5 years of related professional experience.
• Experience in Medicare and/or health insurance is required.
• Strong understanding of health insurance benefits, policies, and procedures.
• Strong time-management and case-management skills.
• Ability to research and analyze complex cases independently.
• Excellent written and verbal communication skills.
• Ability to handle confidential and sensitive information.
• Strong attention to detail and ability to meet regulatory deadlines.
• Bachelor's degree or advanced degree preferred.
• Candidates without a degree may be considered with 5 years of relevant experience.
• Experience handling claims, appeals, and grievances.
• Experience with coding disputes.
• Knowledge of medical terminology and healthcare coding.
• Experience working with Medicare-related cases.
• Certified Professional Coder (CPC) certification is preferred for coding-dispute responsibilities; certification may be required within the first year of employment for applicable responsibilities.
• Medicare / Health Insurance
• Appeals & Grievances
• Claims
• Case Management
• Research & Investigation
• Medical Terminology
• Coding
• Regulatory Compliance
• Time Management
• Written Communication
• Provider Outreach
• Documentation
• Multitasking and Prioritization
Education
• Bachelor's degree or advanced degree preferred.
• Candidates without a degree may be considered with 5 years of relevant experience.

Apply