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Medical Claims Jobs in Raleigh, NC (NOW HIRING)

Elevance Health

Claims Representative I

Durham, NC · On-site

$16.23 - $24.36/hr

Claims Representative I Claims Representative I Location : This role enables associates to work ... medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase ...

Iatinsurancegroup

Manager, Claims Services

Raleigh, NC · Hybrid

$72K - $157K/yr

The Casualty Claims department within IAT Insurance Group has an immediate opening for a Manager of Claims Services in our Auto-PD department.The Manager is a strong technical leader with operational ...

Actalent

Pharmacy Technician

Raleigh, NC · On-site

$17 - $20.75/hr

Run medical claims as needed and document concise, clear progress notes so other team members can quickly assess the status of referrals and ongoing cases. * Use the pharmacy management information ...

IAT Insurance Group

Manager, Claims Services

Raleigh, NC · On-site

$72K - $157K/yr

The Casualty Claims department within IAT Insurance Group has an immediate opening for a Manager of Claims Services in our Auto-PD department. The Manager is a strong technical leader with ...

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Showing results 21-40

All JobsMedical Claims JobsMedical Claims Jobs in Raleigh, NC

Medical Claims information

See Raleigh, NC salary details

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How much do medical claims jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for medical claims in Raleigh, NC is $16.36, according to ZipRecruiter salary data. Most workers in this role earn between $14.95 and $17.74 per hour, depending on experience, location, and employer.

What are medical claims?

Medical claims are formal requests submitted by healthcare providers or patients to insurance companies, asking for payment for medical services rendered. These claims contain detailed information about the patient, the services provided, dates of service, and relevant medical codes. Insurance companies review the claims to determine coverage and reimburse providers or patients accordingly. Accurate and timely submission of medical claims is crucial to ensure proper payment and avoid delays or denials.

How to become a medical claims examiner?

To become a medical claims examiner, candidates typically need a high school diploma or equivalent, with some roles requiring postsecondary education or certification in health insurance or medical billing. Relevant skills include attention to detail, knowledge of medical terminology, and familiarity with claims processing software; certifications such as the Certified Medical Claims Examiner (CMCE) can enhance job prospects.

What are the key skills and qualifications needed to thrive as a medical claims specialist?

To thrive as a Medical Claims Specialist, you need knowledge of medical terminology, insurance policies, and claims processing, typically supported by a high school diploma or relevant certification. Familiarity with claims management software, electronic health records (EHRs), and billing systems such as ICD-10 and CPT coding is essential. Attention to detail, strong organizational skills, and effective communication help ensure accuracy and resolve claim discrepancies. These skills are crucial for ensuring timely and accurate claims processing, minimizing errors, and maintaining compliance with healthcare regulations.

What are some common challenges faced in a medical claims role, and how can they be effectively managed?

Medical claims professionals often encounter challenges such as handling denied or complex claims, navigating frequent regulatory changes, and communicating with both patients and insurance providers. Staying updated with the latest healthcare regulations and payer requirements is essential to minimize claim rejections. Effective time management, attention to detail, and strong communication skills help resolve issues quickly and ensure accurate processing. Collaborating closely with billing teams and healthcare providers also aids in addressing discrepancies and expediting claim approvals.

What is the difference between Medical Claims vs Medical Billing Specialist?

AspectMedical ClaimsMedical Billing Specialist
CredentialsTypically requires knowledge of insurance policies and coding; certifications like CPC or CCS are commonRequires similar certifications; focuses on billing processes and insurance claims
Work EnvironmentHealthcare facilities, insurance companies, billing companiesMedical offices, hospitals, billing companies
Job FocusSubmitting and managing insurance claims for reimbursementPreparing and sending bills to patients and insurers, managing accounts

Medical Claims specialists primarily handle the submission and management of insurance claims to ensure healthcare providers receive payment. Medical Billing Specialists focus on creating and sending bills to patients and insurance companies, managing payments, and maintaining billing records. While both roles require knowledge of insurance processes and coding, Medical Claims roles are more centered on claims submission and follow-up, whereas Medical Billing Specialists handle the overall billing process and patient invoicing.

Is medical claims processing a stressful job?

Medical claims processing can be stressful due to tight deadlines, high accuracy requirements, and the need to handle complex or disputed claims. The job often involves detailed data entry, familiarity with insurance policies, and sometimes dealing with frustrated clients, which can contribute to stress levels. However, workload and stress vary depending on the employer and individual workload management skills.
What are the most commonly searched types of Medical Claims jobs in Raleigh, NC? The most popular types of Medical Claims jobs in Raleigh, NC are:
What are popular job titles related to Medical Claims jobs in Raleigh, NC? For Medical Claims jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Medical Claims jobs in Raleigh, NC look for? The top searched job categories for Medical Claims jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Medical Claims jobs? Cities near Raleigh, NC with the most Medical Claims job openings:
Medical Claims jobs near you
Infographic showing various Medical Claims job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 15% Part Time, and 8% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $34,022 per year, or $16.4 per hour.

Director of Claims, Workers' Compensation

Builders Mutual

Raleigh, NC • On-site

Full-time

Posted 19 days ago

Job description

Description
At Builders Mutual, we believe in the power of teamwork to get the job done right. For more than 40 years, we've helped protect and advance the construction community through commercial insurance, safety expertise, and trusted partnership. Our success has always been built on strong relationships-with our customers, agency partners, and one another.
Rooted in teamwork, expertise, inclusion, and community, we're committed to creating an environment where people do meaningful work, feel supported by leaders who care, and grow their careers with confidence.
The Opportunity
We are seeking a Director of Claims, Workers' Compensation for a hybrid role based in Raleigh, NC. This position will guide the financial and operational performance of our multi-state Workers' Compensation claims portfolio while helping translate enterprise claims strategy into day-to-day execution across a team of adjusters, supervisors, and support staff.
You'll partner closely with the Vice President of Claims on loss trend analysis, business case development, budget planning, and readiness for expansion into new states. You'll also share Workers' Compensation claims insights with Underwriting, Actuarial, and executive leadership; identify emerging risks and cost drivers; recommend data-supported solutions; and lead implementation from concept through measurable results.
Your work as the Director of Workers' Compensation Claims will make a difference as you:
  • Own the financial performance of the Workers' Compensation portfolio, including loss ratio, reserve adequacy, and claim duration targets.
  • Partner with the VP of Claims to develop and execute annual department strategy, operating plans, and budgets.
  • Conduct portfolio-level loss trend analyses to identify severity drivers, emerging exposures, and state-level outliers.
  • Provide technical leadership on complex and catastrophic claims, including reserve/settlement authority and litigation strategy.
  • Assess and build claims operational readiness to support planned expansion into new state markets.
  • Leverage claims data and predictive analytics to inform reserving, litigation, and settlement strategies.
  • Lead, coach, and develop a high-performing claims team, fostering a culture of technical excellence and accountability.
  • Drive adoption of innovative solutions, including AI-assisted analytics and automation, to enhance file handling efficiency.
  • Govern third-party vendor relationships (SIU, medical management, defense counsel) for performance and cost-effectiveness.
  • Collaborate cross-functionally with Underwriting, Actuarial, and Legal to address service, profitability, and litigation risk.

Travel Requirements: At least 10-15% for meetings, industry conferences, and state regulatory or vendor engagements.
Skills and experience to get the job done right:
• Bachelor's degree preferred and minimum of 10 years of insurance company claims experience, or an equivalent combination of education and experience. Completed industry designations such as AIC, CPCU are a plus.
• Five (5) or more years of progressive management experience in a Workers' Compensation claims operations environment. Prior construction-related, multi-jurisdictional Workers' Compensation claims management experience is preferred.
• Demonstrated ability to own financial results, including loss ratio and reserve accuracy, and to translate data analysis into actionable strategy.
• Sound judgment, initiative, and ownership in leading complex, multi-jurisdictional claims and cross-functional projects.
• Strong verbal and written communication skills, including the ability to present findings and recommendations to executive leadership.
• Ability to design and map claims workflows for greater efficiency, and to lead process or technology change.
• Demonstrated executive presence and ability to influence senior leadership through data-driven recommendations
Work With Us
At Builders Mutual, we're intentional about creating a workplace where people can do meaningful work, feel supported by leaders who care, and grow their careers with confidence.
As a member of our leadership team, you'll help shape the employee experience, strengthen organizational capability, and support the future of our company. You'll work alongside colleagues who value expertise, teamwork, inclusion, and community while making a meaningful impact on our people, our customers, and our business.
Builders Mutual is an Equal Opportunity Employer.

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