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Senior Claims Representative Jobs in Raleigh, NC

Stantec Inc.

Senior Project Manager

Raleigh, NC · On-site

Your Opportunity Stantec is seeking an individual to act as an Owner's Representative, Senior ... Evaluate, advise on and assist in resolving disputes and claims. * Responsible for conducting post ...

Stantec

Senior Project Manager

Raleigh, NC · On-site

Your Opportunity Stantec is seeking an individual to act as an Owner's Representative, Senior ... Evaluate, advise on and assist in resolving disputes and claims. * Responsible for conducting post ...

Stantec

Senior Project Manager

Raleigh, NC · On-site

Your Opportunity Stantec is seeking an individual to act as an Owner's Representative, Senior ... Evaluate, advise on and assist in resolving disputes and claims. * Responsible for conducting post ...

McKesson

Senior Sales Executive, 340B

Cary, NC · Remote

The representative will work closely with internal pharmacy teams and external stakeholders to ... Experience with pharmacy claims adjudication and inventory management systems. * Experience with ...

McKesson

Senior Sales Executive, 340B

Cary, NC · Remote

The representative will work closely with internal pharmacy teams and external stakeholders to ... Experience with pharmacy claims adjudication and inventory management systems. * Experience with ...

Sedgwick

Vice President, Clinical Pharmacy

Raleigh, NC · On-site

$125K - $165K/yr

The role represents Sedgwick as a recognized voice in the industry. ARE YOU AN IDEAL CANDIDATE? We ... senior stakeholders * Strong analytical skills, with the ability to interpret claims and book-of ...

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All JobsClaims Representative JobsSenior Claims Representative JobsSenior Claims Representative Jobs in Raleigh, NC

Senior Claims Representative information

See Raleigh, NC salary details

$11

$23

$40

How much do senior claims representative jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for senior claims representative in Raleigh, NC is $23.45, according to ZipRecruiter salary data. Most workers in this role earn between $17.74 and $26.63 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a senior claims representative, and why are they important?

To thrive as a Senior Claims Representative, you need in-depth knowledge of insurance policies, claims adjudication, and investigative techniques, usually backed by relevant experience or a related degree. Familiarity with claims management systems, regulatory compliance tools, and sometimes industry certifications like AIC or CPCU is typically expected. Excellent negotiation, analytical thinking, and customer service skills help build trust and resolve complex claims efficiently. These abilities ensure accurate, fair, and timely claims processing, maintaining customer satisfaction and minimizing organizational risk.

What is the difference between Senior Claims Representative vs Claims Adjuster?

AspectSenior Claims RepresentativeClaims Adjuster
Required CredentialsHigh school diploma or equivalent; often some insurance certificationsHigh school diploma or equivalent; insurance licenses often required
Work EnvironmentOffice setting, claims departmentField or office-based, investigating claims
Employer & Industry UsageInsurance companies, claims departmentsInsurance companies, third-party administrators
Common Search & ComparisonSenior Claims Representative vs Claims Adjuster

The main difference is that Senior Claims Representatives often handle more complex claims and may have additional responsibilities, while Claims Adjusters focus on investigating and settling claims, sometimes in the field. Both roles require similar credentials and work within insurance companies, but Senior Claims Representatives typically have more experience and authority in decision-making.

What does a senior claims representative do?

A Senior Claims Representative is responsible for handling complex insurance claims, investigating and evaluating them, and determining the extent of the insurance company’s liability. They review documentation, interview claimants and witnesses, and negotiate settlements in accordance with company and legal guidelines. In addition, they may mentor junior staff and ensure that claims are processed efficiently and in compliance with policies. Their role is critical in ensuring fair outcomes for both the insurer and the insured.

What are some common challenges faced by senior claims representatives, and how can they effectively manage complex claims?

Senior Claims Representatives often handle high-value or intricate claims that require thorough investigation, negotiation, and adherence to regulatory guidelines. Challenges can include managing multiple cases simultaneously, working with difficult claimants, and balancing the interests of clients, policyholders, and the company. Effective management involves strong organizational skills, continuous communication with stakeholders, and staying current with industry best practices. Collaboration with legal teams, adjusters, and underwriters is also crucial to ensure fair and timely resolutions.
What are the most commonly searched types of Claims Representative jobs in Raleigh, NC? The most popular types of Claims Representative jobs in Raleigh, NC are:
What are popular job titles related to Senior Claims Representative jobs in Raleigh, NC? For Senior Claims Representative jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Senior Claims Representative jobs in Raleigh, NC look for? The top searched job categories for Senior Claims Representative jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Senior Claims Representative jobs? Cities near Raleigh, NC with the most Senior Claims Representative job openings:
Senior Claims Representative jobs near you
Infographic showing various Senior Claims Representative job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, and 3% Contract. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution, with an average salary of $48,776 per year, or $23.4 per hour.

Intake Care Senior Representative

Spectraforce Technologies

Raleigh, NC • On-site

$18.75 - $25.75/hr

Other

Posted 4 days ago

Job description

Position Title: Intake Care Senior Representative

Work Location: Remote

Assignment Duration: 5 Months

Work Schedule: Training Hours: Monday through Friday 8:30 AM - 5:00 PM CT. Standard shifts occur Monday through Friday 7:00 AM - 7:00 PM CT.

Work Arrangement: Remote

Position Summary
Candidate can be located in any time zone as long as they can commit to the CST hours for the role. 10:30-7 CST.

The Advocate role is a non-clinical customer service position within an inbound call center that supports behavioral health services.

Advocates are responsible for handling inbound calls from both members and providers or their office support staff regarding mental health or substance use disorder services.

Background & Context

The nature of discussions within the Behavioral Advocate role often delve into personal and sensitive topics with members.

It demands a nuanced understanding of mental health and substance use issues.

This role differs from its medical counterpart in that mental health is a sensitive subject and staff are helping members navigate complex and emotional mental health challenges.

Key Responsibilities

* The primary responsibility of this role is to answer inbound calls from members and providers.

* The work environment is structured, and the majority of the day will be spent answering these calls from a queue.

* Occasional outbound calls may be necessary for issues requiring follow-up.

* Use active listening and empathy skills to triage and assess for risk of harm and substance use concerns

* Coordinate with multiple matrix partners, and facilitate seamless hand offs to clinical partners for timely support

* Communicate eligibility, generate a list of provider referrals, quote benefits, or advise of authorization requirements for services

* Write authorizations to ensure claims are paid correctly

* Provide follow-up on issues by making outbound calls when necessary

* Send resources to members and providers via email

* Submit a complaint on the members or provider's behalf

* Independently problem-solve to ensure accurate information is given, and exceptional customer service and first call resolution is achieved

Qualification & Experience

* Customer Service experience

* Prior experience working in a patient focused mental health environment preferred

* Ability to maintain a professional and positive image to external customers

* Candidate must possess superb interpersonal communication skills

* Effective listening and organizational skills, with the ability to manage multiple tasks

* Intuitive technical capabilities with the ability to quickly understand and apply working knowledge on several proprietary systems

* Independent problem solving skills

* Able to excel and/or prior successful experience in a virtual team environment

* Strong time management skills

* Ability to type effectively and have strong PC skills

* Use active listening and empathy skills to triage and assess for risk of harm and substance use concerns

* Intuitive technical capabilities with the ability to quickly understand and apply working knowledge on several proprietary systems

* Effective listening and organizational skills, with the ability to manage multiple tasks

Education

* Due to the complexity of assessing members for risk of harm and substance use concerns, legal requires a bachelor's degree in the mental health field or psychology/social work-related field (family communications, health coaching, community/public health or other related major), or a bachelor's degree in an unrelated field and 2+ years of experience in the behavioral health field.

Additional Information

* Candidates MUST have reliable internet connection

* Initial training for this position will be focused on member calls regarding triage, referrals, benefits, eligibility, and other support resources.

* Additional training on provider calls will take place once an Advocate becomes proficient in speaking to members.

Apply