Complex Claims Specialist Jobs
Complex Claims Specialist jobs are open across insurance carriers, third-party administrators, and healthcare systems, from entry-level adjusters to senior and lead specialists, with specializations in workers' compensation, liability, and medical claims. See the openings below and apply to the ones that match your experience.
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Iberia Medical Center (IMC) in New Iberia, LA is looking for team members who will help advance our vision to be the premier hospital of choice for patients, physicians and employees. We've been caring for our community for over 60 years and offer many diverse career paths. Our new employees experience opportunities to learn and grow while caring for their families, friends and neighbors.
IMC is currently looking for a PFS Complex Claims Specialist , who ensures Ensures all assigned complex Commercial, Workers’ Compensation, VA, Blue Cross, Medicare Advantage, Medicaid, and specialty claims are researched, resolved, appealed, and collected in a timely and accurate manner. Handles complex insurance denials, appeals, payment disputes, refund requests, and overpayment investigations to ensure appropriate reimbursement and timely resolution of outstanding accounts. Monitors assigned billing reports, researches payer policy changes, identifies denial trends, and communicates findings to leadership to improve billing accuracy, reduce denials, and enhance revenue cycle performance.
SCHEDULE
- Full-Time
- Monday through Friday 8:00am- 4:30pm
JOB RELATIONSHIP
- WORKERS SUPERVISED: None
- SUPERVISED BY: PFS Assistant Manager
QUALIFICATIONS:
- Education: High school graduate or equivalent.
- Licensure/Certification: N/A.
- Training and Experience: Minimum 5 years prior medical billing and insurance collections experience, specific to hospitals.
PRINCIPLE TASKS, DUTIES, AND RESPONSIBILITIES:
- Assists current billers with complex denials, billing issues, and special projects as needed.
- Serves as primary backup for Commercial, Workers’ Compensation, VA, Blue Cross, Medicare Advantage, SNF, Hospice, Copay Assistance, and Medicaid billing and follow-up.
- Prepares and files assigned 121 claims.
- Handles the preparation, billing, and filing of all inpatient and outpatient psychiatric claims and other specialty accounts as assigned.
- Handles high-level disputes, appeals, and escalations for accounts 120 days or older from discharge date.
- Researches and reviews payer refund and overpayment requests to determine appropriate approval or dispute.
- Researches payer policy changes resulting in denials and reports findings to management.
- Communicates denial trends and identifies opportunities for process improvement to the PFS Supervisor and PFS Lead.
- Works daily billing reports, including Late Charge, Secondary Billing, Exceptions, Unchecked, and 24/72-Hour Reports.
- Ensures assigned denials, refile requests, and other insurance correspondence are addressed within 3–5 business days.
- Performs additional duties and responsibilities as assigned by the supervisor.
Iberia Medical Center (IMC) in New Iberia, LA is looking for team members who will help advance our vision to be the premier hospital of choice for patients, physicians and employees. We've been caring for our community for over 60 years and offer many diverse career paths. Our new employees experience opportunities to learn and grow while caring for their families, friends and neighbors.
IMC is currently looking for a PFS Complex Claims Specialist , who ensures Ensures all assigned complex Commercial, Workers’ Compensation, VA, Blue Cross, Medicare Advantage, Medicaid, and specialty claims are researched, resolved, appealed, and collected in a timely and accurate manner. Handles complex insurance denials, appeals, payment disputes, refund requests, and overpayment investigations to ensure appropriate reimbursement and timely resolution of outstanding accounts. Monitors assigned billing reports, researches payer policy changes, identifies denial trends, and communicates findings to leadership to improve billing accuracy, reduce denials, and enhance revenue cycle performance.
SCHEDULE
- Full-Time
- Monday through Friday 8:00am- 4:30pm
JOB RELATIONSHIP
- WORKERS SUPERVISED: None
- SUPERVISED BY: PFS Assistant Manager
QUALIFICATIONS:
- Education: High school graduate or equivalent.
- Licensure/Certification: N/A.
- Training and Experience: Minimum 5 years prior medical billing and insurance collections experience, specific to hospitals.
PRINCIPLE TASKS, DUTIES, AND RESPONSIBILITIES:
- Assists current billers with complex denials, billing issues, and special projects as needed.
- Serves as primary backup for Commercial, Workers’ Compensation, VA, Blue Cross, Medicare Advantage, SNF, Hospice, Copay Assistance, and Medicaid billing and follow-up.
- Prepares and files assigned 121 claims.
- Handles the preparation, billing, and filing of all inpatient and outpatient psychiatric claims and other specialty accounts as assigned.
- Handles high-level disputes, appeals, and escalations for accounts 120 days or older from discharge date.
- Researches and reviews payer refund and overpayment requests to determine appropriate approval or dispute.
- Researches payer policy changes resulting in denials and reports findings to management.
- Communicates denial trends and identifies opportunities for process improvement to the PFS Supervisor and PFS Lead.
- Works daily billing reports, including Late Charge, Secondary Billing, Exceptions, Unchecked, and 24/72-Hour Reports.
- Ensures assigned denials, refile requests, and other insurance correspondence are addressed within 3–5 business days.
- Performs additional duties and responsibilities as assigned by the supervisor.
Complex Claims Specialist Jobs by Experience Level
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Find JobsComplex Claims Specialist Job Market
Who's Hiring
Top Industries Hiring
- Insurance
What Employers Look For
The qualifications that appear most often in complex claims specialist jobs.
- 3-5 years of experience handling complex or litigated insurance claims
- Active state adjuster license in the relevant jurisdiction or multiple states
- Proficiency with claims management systems such as Guidewire or similar platforms
- Strong knowledge of coverage analysis, policy interpretation, and reserving practices
- Experience coordinating with defense counsel, medical providers, and expert witnesses
- Associate in Claims (AIC) or Chartered Property Casualty Underwriter (CPCU) designation preferred
Tips for Your Complex Claims Specialist Job Search
Quantify settlements and closure rates on your resume
Hiring managers for complex claims roles want to see outcomes, not duties. List the average settlement values you handled, your file closure percentages, and any litigation cost reductions you contributed to. Numbers give reviewers a concrete sense of your caseload complexity.
Highlight your specific line of authority
Your reserve-setting authority and settlement limit are signals of seniority that generic adjuster resumes miss entirely. State your line of authority clearly and tie it to claim types, whether workers' comp, general liability, or commercial auto, so recruiters can match you to the right level.
Target postings that name your certifications explicitly
Filter openings by the certifications you hold, such as AIC, CPCU, or state adjuster licenses. Roles that list those credentials in requirements are far more likely to advance your application than postings written for a generalist, and they signal the employer already values your background.
Apply early to roles that fit
Migrate Mate lists complex claims specialist openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Prepare for coverage-dispute scenario questions
Interviewers at carriers and TPAs routinely ask you to walk through how you'd handle a disputed coverage determination or a claimant threatening litigation. Practice explaining your investigation steps, documentation approach, and escalation thresholds out loud before your first interview.
Negotiate using total compensation, not base salary alone
Complex claims roles often include productivity bonuses tied to file closures or savings benchmarks. When you receive an offer, ask how the bonus structure is calculated and what top performers typically earn through it, so you're comparing full compensation packages, not just base figures.
Complex Claims Specialist Jobs: Frequently Asked Questions
Which companies are hiring the most complex claims specialists?
Liberty Mutual Insurance, CNA Insurance, and The Hartford are hiring the most complex claims specialists right now, with openings concentrated in New York, Illinois, and Texas, based on current listings on Migrate Mate as of November 2026. Demand is especially strong at large carriers and third-party administrators managing high-volume workers' compensation and liability portfolios.
How many complex claims specialist jobs are remote?
About 90% of complex claims specialist openings are fully remote or hybrid as of November 2026, reflecting carriers' and TPAs' shift toward distributed adjusting teams. Remote availability is highest for workers' compensation and commercial liability roles, where most work involves phone, email, and document review rather than in-person field inspections.
How do you become a complex claims specialist?
Start by earning a bachelor's degree in a related field such as business, finance, or risk management, then obtain the state adjuster license required in your target market. Build foundational experience handling standard claims before moving into complex or litigated files. Earning designations like the AIC or CPCU and developing working knowledge of coverage law and litigation management will accelerate your path to complex roles.
Can you get hired as a complex claims specialist with little experience?
Some carriers hire candidates with one to two years of general claims experience into complex roles through internal training programs, particularly in workers' compensation lines where volume creates consistent openings. Emphasizing any exposure to litigated files, attorney correspondence, or high-value reserves, even in a support capacity, helps differentiate your application from others at a similar experience level.
What does the complex claims specialist interview process look like?
Most employers run a phone screen focused on your license status and claims background, followed by a structured panel interview with a claims manager and sometimes a legal or risk team member. You'll typically be asked to walk through a complex claim scenario from investigation to resolution. Some carriers include a written coverage analysis exercise or a case study review as a final step.
Where can I find and apply to complex claims specialist jobs?
You can find and apply to complex claims specialist jobs on Migrate Mate, which lists current openings from across the United States in one place. Search for roles that match your license, line of authority, and specialty, then apply directly to each listing that fits your background.
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