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Adjudication Jobs in California (NOW HIRING)

Molina Healthcare

Examiner, Claims

Long Beach, CA · Remote

$14 - $26.42/hr

Essential Job Duties Evaluates the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste ...

NORTH EAST MEDICAL SERVICES

$38/hr

Perform the daily examination, auditing and adjudication activities to submitted professional claims based on established utilization criteria, Medi-Cal and/or Medicare guidelines, member's Evidence ...

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Adjudication information

See California salary details

$15

$36

$46

How much do adjudication jobs pay per hour?

As of Aug 27, 2026, the average hourly pay for adjudication in California is $36.50, according to ZipRecruiter salary data. Most workers in this role earn between $31.06 and $42.21 per hour, depending on experience, location, and employer.

What is adjudication?

An adjudication job involves reviewing and analyzing claims, applications, or cases to determine eligibility, compliance, or resolution based on established guidelines and policies. Adjudicators work in various fields such as insurance, legal disputes, government benefits, and background checks. Their role includes reviewing documents, verifying information, and making impartial decisions to ensure fair outcomes. Strong attention to detail, analytical skills, and knowledge of relevant regulations are essential for this role.

What are the common responsibilities of adjudication?

Professionals working in Adjudication are responsible for reviewing claims, appeals, or disputes to determine their eligibility or validity based on established guidelines and regulations. Daily tasks often include gathering and analyzing evidence, preparing detailed reports, and communicating decisions to involved parties while ensuring compliance with all applicable laws and policies. Adjudicators also collaborate frequently with internal teams such as customer service, legal, and compliance departments to ensure thorough and accurate decision-making. This role often involves managing multiple cases simultaneously, making strong organizational and time-management skills essential for success.

What are the key skills and qualifications needed for adjudication?

To excel in an Adjudication role, candidates typically need strong analytical abilities, attention to detail, and a background in legal, insurance, or compliance fields, often supported by a relevant degree or professional certification. Familiarity with case management systems, claims processing software, and regulatory databases is commonly required. Excellent problem-solving, communication, and impartial decision-making skills help professionals stand out in this position. These attributes are critical for ensuring fair, consistent, and efficient resolutions in complex claims or disputes.

How much does a claim adjudicator make?

A claim adjudicator typically earns between $40,000 and $70,000 annually, depending on experience, location, and the employer. The role often requires strong attention to detail and knowledge of insurance policies or healthcare regulations.

What are the most commonly searched types of Adjudication jobs in California?

The most popular types of Adjudication jobs in California are:

What are popular job titles related to Adjudication jobs in California?

For Adjudication jobs in California, the most frequently searched job titles are:

What job categories do people searching Adjudication jobs in California look for?

The top searched job categories for Adjudication jobs in California are:

What cities in California are hiring for Adjudication jobs?

Cities in California with the most Adjudication job openings:

Adjudication jobs near you
Infographic showing various Adjudication job openings in California as of August 2026, with employment types broken down into 78% Full Time, 18% Part Time, and 4% Contract. Highlights an 72% Physical, 5% Hybrid, and 23% Remote job distribution, with an average salary of $75,928 per year, or $36.5 per hour.

Adjudication Lead - Roseville, CA (Hybrid)

Gainwell Technologies LLC

Roseville, CA • Hybrid

$70K - $76K/yr

Full-time

Medical, Life, Retirement, PTO

Posted 7 days ago

Gainwell Technologies rating

7.8

Company rating: 7.8 out of 10

Based on 82 frontline employees who took The Breakroom Quiz

139th of 246 rated software companies

Job description

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

Your role in our mission
  • Answers questions from the claims adjudication team and responds to complex customer inquiries or routes them to the appropriate personnel.
  • Researches and responds to customer inquiries in a timely manner.
  • Processes requests and updates account history with proper documentation.
  • Processes and distributes incoming and outgoing work in accordance with service level agreements.
  • Performs data entry and matches documents to the appropriate accounts.Interfaces with team members, management, and customers regarding claim adjudication issues.
  • Reviews client reports daily to ensure data integrity and submits reports to management.
  • Recommends workflow and procedure improvements to support efficient transaction processing.
  • Monitors daily claims transactions to ensure compliance with policies, procedures, and service level agreements.
  • Assists with day-to-day claims adjudication operations, including training and mentoring less experienced staff.
What we're looking for
  • High school diploma or G.E.D. 
  • Three or more years of Claims, TARs, CIFs. NOAs, RTDs experience 
  • Experience working with organizational functions and personnel 
  • Experience working with, computer software, and CRM technology, and Mainframe 
  • Experience working with and skilled in the use of help desk software
What you should expect in this role
  • Remote hybrid work arrangement with 2 days per week in the Roseville, CA office, depending on business and client needs.
  • Monday through Friday schedule.
  • Up to 10% travel required.
 
This position will remain open for applications through September 10, 2026.

The pay range for this position is $70,304.00 - $76,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

What Gainwell Technologies employees say

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About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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