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Direct Claims Jobs in Appleton, WI (NOW HIRING)

Network Health

Associate Medical Director

Menasha, WI · On-site +1

In support of the CMO, the Associate Medical Director is responsible for the administration of ... claims review * Assist in the training of NHP staff on matters relating to medical guidelines

Health Direct

Pharmacist

Appleton, WI

$81.93K - $123.50K/yr

Oversees the initial submission, resubmission and collection of all third party claims * Manages and balances the pharmacy inventory to ensure maximum turns while still remaining in-stock for ...

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Direct Claims information

See Appleton, WI salary details

$29.8K

$63K

$87.8K

How much do direct claims jobs pay per year?

As of May 30, 2026, the average yearly pay for direct claims in Appleton, WI is $63,041.00, according to ZipRecruiter salary data. Most workers in this role earn between $49,800.00 and $73,700.00 per year, depending on experience, location, and employer.

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 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 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 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 Appleton, WI? For Direct Claims jobs in Appleton, WI, the most frequently searched job titles are:
What job categories do people searching Direct Claims jobs in Appleton, WI look for? The top searched job categories for Direct Claims jobs in Appleton, WI are:
What cities near Appleton, WI are hiring for Direct Claims jobs? Cities near Appleton, WI with the most Direct Claims job openings:
Direct Claims jobs near you

Field Claims Representative

Auto Owners Insurance Company

Appleton, WI • Hybrid

Full-time

Retirement, PTO

Posted 15 days ago

Job description

A career at Auto-Owners is challenging and rewarding. Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs.

Job Description

We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team

Auto-Owners Insurance, a top-rated insurance carrier, is seeking a motivated and experienced field claims professional to join our team. This job handles insurance claims in the field under general supervision through the life-cycle of a claim including but not limited to: investigation, evaluation, and claim resolution. This job provides service to agents, insureds, and others to ensure claims resolve accurately and timely. This job requires mastery of claims-handling skills and requires the person to:

  • Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability
  • Handle multi-line property and casualty claims in an assigned territory with an emphasis on property claims
  • Become familiar with insurance coverage by studying insurance policies, endorsements and forms
  • Work toward the resolution of claims, and attend arbitrations, mediations, depositions, or trials as necessary
  • Ensure that claims payments are issued in a timely and accurate manner
  • Handle investigations by phone, mail and on-site investigations

Desired Skills & Experience

  • Bachelor's degree or direct equivalent experience handling property and casualty claims
  • A minimum of 3 years handling multi-line property and casualty claims with an emphasis on property claims
  • Field claims handling experience is preferred but not required
  • Knowledge of Xactimate software is preferred but not required
  • Above average communication skills (written and verbal)
  • Ability to resolve complex issues
  • Organize and interpret data
  • Ability to handle multiple assignments
  • Ability to effectively deal with a diverse group individuals
  • Ability to accurately deal with mathematical problems, including, geometry (area and volume) and financial areas (such as accuracy in sums, unit costs, and the capacity to read and develop understanding of personal and business finance documents)
  • Ability to drive an automobile, possess a valid driver license, and maintain a driving record consistent with the Company's underwriting guidelines for coverage

Benefits

Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you!

Equal Employment Opportunity

Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law.

*Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.

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