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Health Insurance Claims Adjuster

Clearwater, FL · On-site

Health Insurance Claims Adjuster Insurance Administrative Solutions Clearwater, FL About Insurance Administrative Solutions Insurance Administrative Solutions, L.L.C. ("IAS"), an Integrity company ...

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Director Health Insurance Claims information

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$83.5K

$126.9K

$178K

How much do director health insurance claims jobs pay per year?

As of Sep 9, 2026, the average yearly pay for director health insurance claims in the United States is $126,879.00, according to ZipRecruiter salary data. Most workers in this role earn between $105,500.00 and $141,000.00 per year, depending on experience, location, and employer.

What does a director health insurance claims do?

A Director of Health Insurance Claims oversees the entire claims management process within a health insurance organization. Their responsibilities include leading claims teams, ensuring compliance with regulations, optimizing operational efficiency, and resolving complex or escalated claims issues. They develop policies and strategies to improve claims processing accuracy and timeliness, work closely with other departments, and may be involved in budgeting, reporting, and staff training. The role requires strong leadership, analytical skills, and in-depth knowledge of health insurance regulations and procedures.

What are the key skills and qualifications needed to thrive as a director health insurance claims?

To thrive as a Director of Health Insurance Claims, you need in-depth knowledge of claims processing, healthcare regulations, and strong leadership abilities, typically supported by a bachelor's degree in business, healthcare administration, or a related field. Familiarity with claims management software, data analytics tools, and compliance systems such as HIPAA is vital. Exceptional organizational, communication, and problem-solving skills help drive process improvements and manage teams effectively. These capabilities ensure efficient and compliant claims operations, reduce errors, and enhance customer satisfaction.

What are some common challenges faced by a director health insurance claims, and how can they be addressed?

A Director of Health Insurance Claims often encounters challenges such as managing large teams, ensuring regulatory compliance, and streamlining claims processing for efficiency and accuracy. Balancing the demands of cost containment with customer satisfaction can be particularly complex. Addressing these challenges typically involves implementing robust training programs, leveraging technology like claims management software, and fostering open communication with both internal teams and external partners. Staying updated on industry regulations and best practices also helps to minimize errors and maintain high performance.

What is the difference between Director Health Insurance Claims vs Claims Manager?

AspectDirector Health Insurance ClaimsClaims Manager
ResponsibilitiesOversees entire claims department, develops policies, manages teams, and ensures complianceManages daily claims processing, supervises claims staff, and handles escalated claims issues
Required CredentialsTypically requires a bachelor’s degree, industry certifications, and extensive experienceUsually requires a bachelor’s degree and experience in claims processing or management
Work EnvironmentCorporate office, strategic planning, leadership meetingsClaims processing centers, team supervision, operational focus

The main difference between a Director of Health Insurance Claims and a Claims Manager lies in scope and strategic involvement. The director focuses on high-level policies, compliance, and department oversight, while the claims manager handles daily operations and team management. Both roles require relevant industry experience and certifications, but the director's role is more strategic and leadership-oriented.

What are popular job titles related to Director Health Insurance Claims jobs?

For Director Health Insurance Claims jobs, the most frequently searched job titles are:

Infographic showing various Director Health Insurance Claims job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 76% Full Time, 16% Part Time, and 6% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $126,879 per year, or $61 per hour.

Health Insurance Claims Adjuster

Clearwater, FL • On-site

Integritymarketing
See more jobs at Integritymarketingexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 20 days ago

Job description

Health Insurance Claims Adjuster

Insurance Administrative Solutions

Clearwater, FL

About Insurance Administrative Solutions

Insurance Administrative Solutions, L.L.C. ("IAS"), an Integrity company headquartered in Clearwater, Florida, is a third-party administrator providing business process outsourcing for insurance carriers. Formed in 2002, IAS administers policies for insureds residing all across the United States.

Job Summary: Analyze medical claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines.

Primary Responsibilities other duties may be assigned as necessary:

  • Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries.

  • Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions.

  • Interpret contract benefits in accordance with specific claim processing guidelines.

  • Coordinate daily workflow to coincide with check cycle days to meet all service guarantees.

  • Based on established guidelines and/or historical knowledge an adjuster will need to recognize red flags for potential fraud or waste and escalate accordingly.

  • Adjusters who handle the potential fraud or waste claims will investigate, track via clear and complete system notes and accurately report on each file/case in a timely manner.

  • Understand broad strategic concept of our business and link these to the day-to-day business functions of claims processing.

  • Maintain external contact with providers/agents/policyholders.

Primary Skills & Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

  • A high school diploma or GED equivalent

  • Minimum of 1 year proven health insurance claims adjudication experience.

  • Insurance background preferred; previous Medical/prescription claims preferred.

  • Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims required.

  • Familiarity with medical terminology, procedures and diagnosis codes preferred.

  • Ability to read and interpret EOB's claim history, and excellent research skills.

  • Familiarity with Microsoft Office products; familiarity with Qiclink software a plus.

  • Ability to calculate deductible and co-insurance amounts.

  • Ability to adapt and respond to different types of people and tasks.

  • Excellent communication and documentation skills.

  • Ability to multi-task, prioritize, and manage time effectively and efficiently.

  • Reliable transportation and the ability to be punctual and dependable.

Benefits Available

  • We value flexibility and recognize the importance of worklife balance. This role will begin as fully onsite to support learning and team integration. As proficiency is demonstrated, hybrid work opportunities may be introduced, dependent on business needs and department practices.

  • Medical/Dental/Vision Insurance

  • 401(k) Retirement Plan

  • Paid Holidays

  • PTO

  • Community Service PTO

  • FSA/HSA

  • Life Insurance

  • Short-Term and Long-Term Disability

About Integrity

Integrity is one of the nation's leading independent distributors of life, health and wealth insurance products. With a strong insurtech focus, we embrace a broad and innovative approach to serving agents and clients alike. Integrity is driven by a singular purpose: to help people protect their life, health and wealth so they can prepare for the good days ahead.

Integrity offers you the opportunity to start a career in a family-like environment that is rewarding and cutting edge. Why? Because we put our people first! At Integrity, you can start a new career path at company you'll love, and we'll love you back. We're proud of the work we do and the culture we've built, where we celebrate your hard work and support you daily. Joining us means being part of a hyper-growth company with tons of professional opportunities for you to accelerate your career. Integrity offers our people a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind.

Headquartered in Dallas, Texas, Integrity is committed to meeting Americans wherever they are - in person, over the phone or online. Integrity's employees support hundreds of thousands of independent agents who serve the needs of millions of clients nationwide. For more information, visit Integrity.com.

Integrity, LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status, or any other characteristic protected by federal, state, or local law. In addition, Integrity, LLC will provide reasonable accommodations for qualified individuals with disabilities.

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