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Direct Claims Jobs in Ohio (NOW HIRING)

Gaig

Claims Director

Cincinnati, OH · On-site

The Claims Director provides leadership and strategic oversight for MidContinent Group's most ... Direct and oversee litigation management, maintaining close engagement with defense counsel to ...

Rumpke

Risk and Claims Manager

Cincinnati, OH · On-site

This position will not oversee and direct other managers Skills & Abilities Needed for Position ... claims is required * A minimum of 5 years direct claim team management experience is required

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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 Ohio? For Direct Claims jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Direct Claims jobs in Ohio look for? The top searched job categories for Direct Claims jobs in Ohio are:
What cities in Ohio are hiring for Direct Claims jobs? Cities in Ohio with the most Direct Claims job openings:
Direct Claims jobs near you
Infographic showing various Direct Claims job openings in Ohio as of July 2026, with employment types broken down into 88% Full Time, 10% Part Time, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.
Claims System Conversion Consultant

Claims System Conversion Consultant

Mount Carmel Health System

Columbus, OH

Part-time

Medical, Dental, Vision

Posted 17 days ago

Mount Carmel Health System rating

7.9

Company rating: 7.9 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

Job description

Employment Type:Part timeShift:Day Shift Description:Support Director of Claims Operations and Manager of System Configuration during implementation of new claims system
  • Provider Data Management and related downstream processes
  • Manages System Configuration functional area purchases and ensures the proper processing of all invoices related to assigned activities.
  • Lead the definition, documentation, implementation and continuous improvement of claims adjudication system management policies, standards and processes.
  • Supports Claims Audit leadership with the analysis of claims processing metrics to ensure optimal performance.
  • Ensures compliance with all regulatory requirements impacting Support Services by collaborating with the Compliance Department and other key functional stakeholders within the organization responsible for execution of policies, standards and processes.
  • Establish partnerships and works closely with key operational and clinical staff to ensure claims system configuration accuracy; develop plans to address any potential system inaccuracies or configuration errors.
  • Investigate and recommend implementation of tools, techniques and processes with potential to improve management of system configuration.
  • Participate in compliance audits and remediate issues identified as required.
  • Provide Subject Matter Expertise throughout the implementation of the new claims system, HealthEdge Healthrules Payor (HRP)
  • Support Director, Claims Operations and Configuration with daily activities and escalation requests throughout the HRP implementation thus enabling Director to commit more resources to the HRP implementation.
  • Support Manager, System Configuration with daily activities and escalation requests throughout the HRP implementation thus enabling Director to commit more resources to the HRP implementation.
  • Education:  Bachelor of Science degree in health care, business administration, or related field preferred.  In lieu of a bachelor’s degree an combination of college course work and 7+ years of experience in managed care or a health plan organization demonstrating ascending roles of responsibility will be considered.
  • Advanced knowledge of health plan medical benefits, provider reimbursement methodologies, medical, dental and vision terminology, advanced knowledge of claim adjudication and benefit plan application for Medicare Advantage plans.
  • Advanced knowledge of CPT, ICD-9, ICD-10 and HCPS coding systems.
  • Uses standard office equipment and must be able to operate a motor vehicle and possess a valid driver's license.
  • Participates in all project related reporting and communication to the steering committee and other stakeholders.
  • Responsible for compliance with Organizational Integrity through raising questions and promptly reporting actual or potential wrongdoing.
  • Clearly articulates assignments and direction
  • Foster teamwork

Our Commitment to Diversity and Inclusion
 

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

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