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Direct Claims Jobs (NOW HIRING)

Tmhcc

1214782 - Claims Supervisor

Kennesaw, GA · On-site

Direct Claims Auditors in resolving problems, making lower-level decisions, releasing over-limit claims, and handling the proper contractual disbursement of excess loss claims. * Educate and train ...

Argo Group

Director, Claims Triage

Rockwood, PA · On-site

Creates and maintains a positive working relationship with all direct reports, peers, and other claims department managers to ensure the Triage Department operations adds value and meets or exceeds ...

New

Imedica

Director, Claims Operations

Madison, WI

$113K - $194K/yr

The Director, Claims Operations oversees end-to-end claims functions, including claims processing, payment recovery, claim analysis and issue resolution, and provider appeals. A skilled people and ...

CareMore Health

Director, Claims Support

California, MD · Remote

$144K - $238K/yr

Direct all aspects of claims intake, adjudication, payment, adjustment, and provider reimbursement activities. * Ensure claims are processed accurately, timely, and in compliance with contractual ...

Safety National

Director, Claims

Saint Louis, MO · On-site

As the Director, Claims, you will play a critical leadership role overseeing Excess Workers' Compensation claims operations while managing and developing a team of Claims Managers. In this role, you ...

Aston Carter

Claims Assistant

Portland, OR · On-site

$22/hr

Direct claims that exceed assigned authority levels to the Claims Specialist and Claims Manager as appropriate. * Interact professionally via phone and email with homeowners, roofers, distributors ...

CareMore Health

$144K - $238K/yr

Direct all aspects of claims intake, adjudication, payment, adjustment, and provider reimbursement activities. * Ensure claims are processed accurately, timely, and in compliance with contractual ...

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All JobsDirect Claims Jobs

Direct Claims information

See salary details

$30.5K

$64.6K

$90K

How much do direct claims jobs pay per year?

As of Jul 2, 2026, the average yearly pay for direct claims in the United States is $64,609.00, according to ZipRecruiter salary data. Most workers in this role earn between $51,000.00 and $75,500.00 per year, depending on experience, location, and employer.

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.

More about Direct Claims jobs
What cities are hiring for Direct Claims jobs? Cities with the most Direct Claims job openings:
What states have the most Direct Claims jobs? States with the most job openings for Direct Claims jobs include:
What job categories do people searching Direct Claims jobs look for? The top searched job categories for Direct Claims jobs are:
Direct Claims jobs near you
Infographic showing various Direct Claims job openings in the United States as of June 2026, with employment types broken down into 99% Full Time, and 1% Part Time. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $64,609 per year, or $31.1 per hour.

1214782 - Claims Supervisor

Tmhcc

Kennesaw, GA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 6 days ago

Job description

Job Description Template-GeneralTokio Marine HCC (TMHCC) brings 50 years of service to the specialty insurance industry, today offering over 100 products to commercial customers in 180 countries around the world.Organic growth and over 60 successful acquisitions have grown our 2022 Gross Written Premium (GWP) to $5 Billion.Our workforce has grown to 4,300 worldwide ... big, but not so big that you cannot make a difference.Our Good Company values, including integrity, empowerment, and commitment to customer service, and a culture of innovation, communication, and collaboration make TMHCC a great place to work.TMHCC Stop Loss, a $2 Billion division within TMHCC, leads the way in providing medical stop loss insurance sold to employers. Medical Stop Loss provides an added layer of insurance protection to employers who choose to self-fund their health benefit plans. Self-funding can incur risks from catastrophic claims, and Medical Stop Loss insurance from Tokio Marine HCC is designed to protect employers from that risk.*This role is located onsite in Kennesaw, GA*Position Summary:Supervises a team of Claims Auditors in the investigation of claims liability and the extent of the liability of submitted claims. Ensures timely accurate processing of claims according to exiting policies and/or contracts.Key Responsibilities:
  • Ensure the efficient operation of the Claims department through supervision of Claims Auditors.
  • Direct Claims Auditors in resolving problems, making lower-level decisions, releasing over-limit claims, and handling the proper contractual disbursement of excess loss claims.
  • Educate and train colleagues and team members in the duties and responsibilities of strong Claims practices. Promote independent thinking based on sound judgment and decisions. Promote Business Unit procedures and philosophies to clients and staff.
  • Access in-house resources including Actuarial, Underwriting, and Marketing departments to assist in attaining business goals.
  • Manage the work flow of the Auditors.
  • Understand and interpret employer plans of health coverage and excess insurance policy.
  • Identify and initiate large-case management, reserve maintenance, and bordereaux reporting.
  • Communicate in writing and verbally with Third-Party Administrator (TPA)/client as needed, including resolving complex problems of a TPA/client.
  • Set claims reserves and adjust as needed.
  • Issue checks for amount of liability, communicates to TPA/client reasons for any amounts not covered by excess policy.
  • Maintain quality, quantity, and turnaround time standards of department and company.
Education, Experience & Knowledge:
  • Possess and have ability to apply broad knowledge of principles, practices, and procedures
  • Excellent written and verbal communications skills with an emphasis on confidentiality, tact, and diplomacy
  • Exceptional organizational and analytical skills; demonstrated ability to manage multiple tasks simultaneously
  • Knowledgeable of industry changes, legal updates, and technical developments related to applicable area of the Company's business to proactively respond to changing business environment
  • Advanced proficiency and experience using Microsoft Office package (Excel, Access, PowerPoint, Word)
  • 4 Year / Bachelors Degree in Business Administration, a related field, or the equivalent education and/or experience
  • Minimum of zero years of leadership experience required, but two years is preferred
Tokio Marine offers a competitive salary and benefits package, including:
  • Generous paid time off (PTO), 12 paid company holidays,
  • 401(k) Retirement Plan with 6% company match.
  • Health and dental insurance, and vision plan available.
  • Company-provided long-term disability and life insurance.
  • Opportunities for advancement in a successful and growing organization.
  • Flexible work schedules and a great work/life balance.
  • Paid Parental Leave.
  • Volunteer Time Off.
  • Enjoy casual dress and work in a modern, comfortable office with free parking.
  • Hybrid work schedule
The Tokio Marine HCC Group of Companies offers a successful, dynamic organization experiencing rapid growth and are seeking energetic and confident individuals to join our team of professionals. The Tokio Marine HCC Group of Companies is an equal-opportunity employer. Please visit www.tmhcc.com for more information about our companies.#LI-CM3#stoploss1

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