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Direct Claims Jobs in Spring, TX (NOW HIRING)

Professional Healthcare Solutions, LLC

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RN/Medical Claims Analyst

Houston, TX · Remote

$32.50 - $34/hr

Responsibilities may include additional research on medical claims data and other sources of ... Ability to conduct self-directed research to uncover problems in Medicare payments made to ...

Cna

Complex Claim Director - Mass Tort Unit

Houston, TX · On-site

Leads a team of Claims Consultants and Consulting Directors that are responsible for the handling of complex, high exposure mass tort and environmental claims, including social media addiction, PFAS ...

Aon

Claim Professional I

Houston, TX · On-site

$21.75 - $29.75/hr

The Claims Professional works under the direction of Bechtel Head of Workers' Compensation and the AON Claims Director, acting independently to manage routine matters while keeping Bechtel Insured ...

Addison Group

Denials Specialist

Houston, TX · On-site

$26 - $28/hr

Direct Hire Benefits: This position is eligible for medical, dental, vision, life insurance and ... This role is ideal for a high-level collector who understands complex technical claims, payor ...

Adroit Partners, LLC

Safety Director

Houston, TX · On-site

Major functions are legal compliance, accident investigation and insurance claims. * Monitor legal ... Direct the forklift training/certification program. * Administer the DOT random drug abuse &alcohol ...

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Showing results 41-60

All JobsDirect Claims JobsDirect Claims Jobs in Spring, TX

Direct Claims information

See Spring, TX salary details

$27.1K

$57.5K

$80.1K

How much do direct claims jobs pay per year?

As of Aug 6, 2026, the average yearly pay for direct claims in Spring, TX is $57,495.00, according to ZipRecruiter salary data. Most workers in this role earn between $45,400.00 and $67,200.00 per year, depending on experience, location, and employer.

What is a direct claim?

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.

Can you work remotely in direct claims jobs?

Many direct claims jobs offer remote work options, especially for roles involving claims processing, customer service, or administrative tasks. Employers may require familiarity with claims management software and good communication skills, and remote positions often involve standard office hours and secure internet connections.

Do I need a degree to be a direct claims specialist?

A degree is not typically required to become a direct claims specialist, but relevant experience, knowledge of insurance policies, and strong communication skills are important. Many employers provide on-the-job training and may prefer candidates with a high school diploma or equivalent. Certifications in insurance or claims processing can enhance job prospects.

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?

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

RN/Medical Claims Analyst

Professional Healthcare Solutions, LLC

Houston, TX • Remote

$32.50 - $34/hr

Full-time

Medical, Dental, PTO

Posted 16 days ago

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Job description

The position requires the Registered Nurse to conduct medical record reviews and to apply sound clinical judgment to claim payment decisions. Responsibilities may include additional research on medical claims data and other sources of information to identify problems and utilize a variety of tools to detect situations of potential fraud and to support the ongoing fraud investigations and requests for information. The Registered Nurse will work with PHS leadership, in concert with our clients, to review cases and produce a concise and accurate summary of determinations. The Registered Nurse will comply with the PHS policies related to Conflict of Interest and Compliance and will abide by the PHS Code of Conduct.

Prerequisite:

  • Current Oklahoma Registered Nursing license and not listed on the OIG Excluded Individual database
  • Two years of experience in the medical field as a Registered Nurse. May substitute one year of clinical experience for experience in review of medical claims for coverage and medical necessity
  • Demonstrated history of professional conduct and success in working independently and as a member of a team
  • Strong interpersonal skills
  • Strong critical thinking and investigative skills
  • Strong verbal and written communication and organization skills
  • Strong computer knowledge and skills, including Microsoft Word and Excel programs

Essential Functions:

  • Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government·
  • Ability to gather information systematically in order to establish facts
  • Ability to research regulations and cite violations
  • Ability to conduct self-directed research to uncover problems in Medicare payments made to institutional and non-institutional providers
  • Ability to make claim payment decisions based on clinical knowledge
  • Ability to compose medical review summary reports and correspondence concisely and accurately
  • Ability to communicate effectively, internally and externally
  • Ability to handle PHI and ePHI in a secure and confidential manner
  • Ability to report work activity on a timely basis
  • Ability to work independently and as a member of a team to deliver high quality work
  • Ability to attend meetings and education offerings.
  • Ability to manage time effectively, prioritizing tasks and able to meet deadlines