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Direct Claims Jobs in Iowa (NOW HIRING)

CBCS

Director, Claims Solutions

Dubuque, IA · On-site

The Claims Solution Leader is a senior-level role responsible for the strategy, performance, and growth of CBCS's ancillary claim solutions portfolio. This leader oversees vendor partnerships ...

CBCS

Director, Claims Solutions

Dubuque, IA · On-site +1

The Claims Solution Leader is a senior-level role responsible for the strategy, performance, and growth of CBCS's ancillary claim solutions portfolio. This leader oversees vendor partnerships ...

CBCS

Director, Claims Solutions

Dubuque, IA

The Claims Solution Leader is a senior-level role responsible for the strategy, performance, and growth of CBCS's ancillary claim solutions portfolio. This leader oversees vendor partnerships ...

Transamerica

Senior Claims Examiner

Cedar Rapids, IA · On-site

$48K - $55K/yr

Work closely with department manager, legal counsel, medical director, claims assistants, and other departments to gather information for contested claims. * Monitor claims for fraud and proceed ...

Aegon

Senior Claims Examiner

Cedar Rapids, IA · On-site +1

$48K - $55K/yr

Work closely with department manager, legal counsel, medical director, claims assistants, and other departments to gather information for contested claims. * Monitor claims for fraud and proceed ...

Nationwide

VP, Claims Agribusiness

Des Moines, IA · Remote

You will direct the activities of strategic and operational initiatives to ensure claim cost and ... Are you an expert in Agribusiness Claims and leading strategic transformations? If you thrive in an ...

Berkley

Manager, Claims

Urbandale, IA · Hybrid

Train, mentor, and supervise claims unit staff to ensure customer service, file quality and staff ... Interviewing, hiring, and training employees; planning, assigning, and directing work; appraising ...

Berkley

Manager, Claims

Urbandale, IA · Hybrid

Train, mentor, and supervise claims unit staff to ensure customer service, file quality and staff ... Interviewing, hiring, and training employees; planning, assigning, and directing work; appraising ...

Berkley

Manager, Claims

Urbandale, IA · On-site

Train, mentor, and supervise claims unit staff to ensure customer service, file quality and staff ... Interviewing, hiring, and training employees; planning, assigning, and directing work; appraising ...

Curi Holdings, Inc.

Senior Claims Consultant

Des Moines, IA · On-site

$120K - $130K/yr

In this role, reporting to the Director of Claims, you will help us coordinate the defense of our insured physicians, hospitals and/or medical providers. You will be responsible for investigating and ...

CBCS

Claims Coordinator

Dubuque, IA · On-site

What our Claims Coordinators do and why it's important Cottingham & Butler is growing and we are ... You will make a direct impact on a daily basis by carrying out the top-tier services that define ...

Cottingham & Butler

Claims Coordinator

Dubuque, IA · On-site

What our Claims Coordinators do and why it's important Cottingham and Butler is growing and we are ... You will make a direct impact on a daily basis by carrying out the top-tier services that define ...

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Showing results 1-20

All JobsDirect Claims JobsDirect Claims Jobs in Iowa

Direct Claims information

What are direct claims?

Direct claims refer to insurance claims that are filed directly by the policyholder with their own insurance company, rather than going through a third party or the at-fault party's insurer. This process is common in situations like auto accidents, where the policyholder seeks compensation for damages or losses under their own policy. Direct claims help streamline the process, reduce delays, and ensure the policyholder receives prompt assistance and settlements. They are often associated with 'first-party' insurance coverage, such as collision, comprehensive, or health insurance claims.

What are some common challenges faced by professionals in Direct Claims roles, and how can they effectively manage these challenges?

Professionals in Direct Claims often face the challenge of balancing a high volume of claims with the need for thorough investigation and timely resolution. Managing customer expectations and handling sensitive situations, such as denied claims or complex cases, can also be demanding. Effective communication, strong organizational skills, and staying updated on policy guidelines are crucial for success. Building collaborative relationships with adjusters, underwriters, and other departments helps ensure accurate and efficient claims processing.

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

To thrive as a Direct Claims Specialist, you need a solid understanding of insurance policies, claims processes, and relevant legal regulations, often supported by a degree in business, finance, or a related field. Familiarity with claims management software, customer relationship management (CRM) systems, and sometimes industry certifications like AIC or CPCU is typical. Exceptional attention to detail, problem-solving abilities, and strong communication skills set top performers apart in this role. These skills and qualifications ensure claims are processed accurately and efficiently, leading to customer satisfaction and minimized risk for the insurer.

What is the difference between Direct Claims vs Claims Adjuster?

AspectDirect ClaimsClaims Adjuster
CredentialsInsurance license, knowledge of policiesInsurance license, sometimes certifications like AIC or CPCU
Work EnvironmentCustomer service, office or remoteFieldwork, office, or remote
Employer & IndustryInsurance companies, agenciesInsurance companies, third-party administrators
Search & Comparison IntentUnderstanding direct claims handlingEvaluating claims adjustment roles

Direct Claims professionals primarily handle claims directly from policyholders, focusing on processing and resolving claims within the insurance company. Claims Adjusters evaluate, investigate, and settle claims, often working in the field or remotely. Both roles require insurance licensing, but Claims Adjusters may have additional certifications. While their work overlaps in claims processing, Direct Claims roles are more customer-facing, whereas Claims Adjusters focus on assessment and negotiation.

What are popular job titles related to Direct Claims jobs in Iowa? For Direct Claims jobs in Iowa, the most frequently searched job titles are:
What job categories do people searching Direct Claims jobs in Iowa look for? The top searched job categories for Direct Claims jobs in Iowa are:
What cities in Iowa are hiring for Direct Claims jobs? Cities in Iowa with the most Direct Claims job openings:
Direct Claims jobs near you
Director, Claims Support

Director, Claims Support

Millennium Physician Group

Nevada, IA • Remote

$144K - $238K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago

Millennium Physician Group rating

6.3

Company rating: 6.3 out of 10

Based on 62 frontline employees who took The Breakroom Quiz

669th of 886 rated healthcare providers

Job description

Job Description Summary

The Director, Claims Support is responsible for the strategic and operational leadership of CareMore Health's claims administration function, ensuring the accurate, timely, and compliant adjudication and payment of medical, behavioral health, pharmacy, and ancillary claims. This role oversees claims operations across multiple markets and systems, drives operational excellence, and ensures compliance with Medicare, Medicaid, Commercial, CMS, and state regulatory requirements.
The Director develops and executes claims strategies that support organizational objectives, provider satisfaction, member experience, payment integrity, and financial stewardship. Serving as a key leader within Health Plan Operations, the Director partners closely with Provider Network Management, Finance, Compliance, Configuration, Delegation Oversight, Appeals & Grievances, Clinical Operations, and external provider organizations to ensure optimal claims performance and regulatory compliance.

How will you make an impact & Requirements

Hours & Location:

Full Time: Monday-Friday, Pacific Time

Remote work

Essential Responsibilities

  • Direct all aspects of claims intake, adjudication, payment, adjustment, and provider reimbursement activities.

  • Ensure claims are processed accurately, timely, and in compliance with contractual, regulatory, and organizational requirements.

  • Provide leadership and guidance on highly complex claims and provider disputes.
    Establish and monitor operational metrics, SLAs, productivity standards, and quality indicators.

  • Lead continuous improvement initiatives focused on automation, efficiency, payment accuracy, and provider experience.

  • Ensure compliance with CMS, Medicare Advantage, Medicaid, and state regulations.

  • Lead strategic planning, budgeting, workforce planning, and operational transformation initiatives.

  • Partner with providers, delegated entities, vendors, and internal stakeholders to resolve issues and improve performance.

  • Lead, coach, and develop managers and claims professionals across multiple locations.

Required Qualifications

  • Bachelor's degree in Business Administration, Healthcare Administration, Finance, Public Health, or related field, or equivalent experience.

  • Minimum 9 years of progressive healthcare claims operations experience.

  • Minimum 5 years of leadership experience managing managers and/or large operational teams.

  • Experience within Medicare Advantage, Medicaid, Managed Care, Health Plan, or Payer environments.

Preferred Qualifications

  • Master's degree (MBA, MHA, MPH, or related field).

  • Experience supporting delegated provider organizations, value-based care models, payment integrity programs, and provider dispute resolution.

Benefits:

  • 3 weeks PTO & 8 paid holidays

  • Medical, Dental, Vision

  • Employer Paid Basic Life & Short Term Disability coverage (goes into effect after 1 year of full-time employment)

  • 401(k) with match

  • Employee Wellness

  • Other Employee Discount programs like Tickets at Work and cell phone discounts

  • Other benefits: Dependent Care FSA, Voluntary Life, Long Term Disability, Critical Illness, Pet Insurance, and more

Compensation:

$144,368.00

to

$238,207.00

What Millennium Physician Group employees say

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