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Adjudication Jobs in Ohio (NOW HIRING)

Riverside Research

Cloud Architect

Fairborn, OH · On-site

$61.50 - $78.25/hr

Ability to obtain a Top Secret clearance with SCI adjudication. * Bachelor's degree and 10+ years of experience in cloud architecture or related roles. * Proven experience designing and managing ...

Managed Staffing

Claims Processor

Mason, OH · On-site

$16 - $20.25/hr

Through demonstrated experience and knowledge, process standard, non-complex claims requiring a basic knowledge of claims adjudication. MAJOR DUTIES & RESPONSIBILITIES: * Processing - Efficiently and ...

MCKESSON Careers

Clinical Pharmacist - Sales

Columbus, OH

$114K - $136K/yr

Understanding of pharmacy benefit design, managed care pharmacy for Commercial lines of business, pharmacy adjudication processes, formulary design, utilization management edits, pharmacy networks ...

Etegent Technologies, LTD

Cloud Engineer

Beavercreek, OH · On-site

$52 - $69.50/hr

Active SCI adjudication. * Experience working with at least one VDI platform (Azure Virtual Desktops, AWS Workspaces, Horizon, etc.) * Thin-client endpoint management experience using software such ...

Sedgwick

Workforce Absence Team Lead

Dublin, OH · On-site

Provides technical/jurisdictional direction to examiner reports on claims adjudication. * Compiles, reviews, and analyzes management reports and takes appropriate action. * Performs quality review on ...

Elevance Health

Provider Escalations Analyst

Mason, OH · On-site

May adjust claims for a specific line of business and market within guidelines to ensure proper adjudication, interpret benefits, policies and procedures, provider contracts, and adjudication of ...

McKesson

Clinical Pharmacist - Sales

Columbus, OH · On-site

$114K - $136K/yr

Understanding of pharmacy benefit design, managed care pharmacy for Commercial lines of business, pharmacy adjudication processes, formulary design, utilization management edits, pharmacy networks ...

Sedgwick

Workforce Absence Team Lead

Dublin, OH · Hybrid

Provides technical/jurisdictional direction to examiner reports on claims adjudication. * Compiles, reviews, and analyzes management reports and takes appropriate action. * Performs quality review on ...

McKesson

Clinical Pharmacist - Sales

Columbus, OH

$114K - $136K/yr

Understanding of pharmacy benefit design, managed care pharmacy for Commercial lines of business, pharmacy adjudication processes, formulary design, utilization management edits, pharmacy networks ...

Etegent Technologies, Ltd

Cloud Engineer

Beavercreek, OH · On-site

$52 - $69.50/hr

Active SCI adjudication. * Experience working with at least one VDI platform (Azure Virtual Desktops, AWS Workspaces, Horizon, etc.) * Thin-client endpoint management experience using software such ...

Elevance Health

Provider Escalations Analyst

Mason, OH · On-site

May adjust claims for a specific line of business and market within guidelines to ensure proper adjudication, interpret benefits, policies and procedures, provider contracts, and adjudication of ...

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Showing results 21-40

All JobsAdjudication JobsAdjudication Jobs in Ohio

Adjudication information

See Ohio salary details

$14

$35

$44

How much do adjudication jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for adjudication in Ohio is $35.16, according to ZipRecruiter salary data. Most workers in this role earn between $29.95 and $40.67 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 Ohio?

The most popular types of Adjudication jobs in Ohio are:

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

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

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

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

What cities in Ohio are hiring for Adjudication jobs?

Cities in Ohio with the most Adjudication job openings:

Adjudication jobs near you
Infographic showing various Adjudication job openings in Ohio as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 12% Part Time, 2% Temporary, and 4% Contract. Highlights an 76% Physical, 4% Hybrid, and 20% Remote job distribution, with an average salary of $73,142 per year, or $35.2 per hour.

Director of Claims & Stop-Loss Transformation - REMOTE

S&S Healthcare

Cincinnati, OH • On-site

$120K - $160K/yr

Other

Re-posted 16 days ago

Key responsibilities

  • Assess current claims and stop-loss capabilities, including processes, technology, and organizational structures.

  • Lead enterprise process redesign initiatives to improve workflows, efficiency, and service performance.

  • Oversee modernization efforts across claims and stop-loss administration, including evaluating workflows and supporting automation opportunities.

Job description

Reflect Health is the evolution of S&S Health, a trusted independent third-party administrator founded in 1994 to meet the growing need for access, simplified connectivity, and benefits administration. Headquartered in Mason, OH, we have built a reputation based on innovation, service excellence, and a deep understanding of how to drive better outcomes at lower cost. Over the years, we grew into a national presence serving employers, TPAs, health systems, and benefit consultants across all 50 states. We developed proprietary claims technology, expanded our offerings to include level-funded and fully funded programs, and delivered tangible savings and enhanced experiences for millions of members.

We are seeking a Director of Claims & Stop-Loss Transformation to lead strategic modernization initiatives that advance the future capabilities of our claims and stop-loss platforms. Reporting to the Chief of Staff, Transformation Office, this role serves as a transformation leader responsible for assessing current-state capabilities, identifying operational gaps, designing future-state operating models, and leading complex initiatives that improve scalability, efficiency, quality, and organizational performance. This role will partner closely with Executive Leadership, Claims Operations, Stop-Loss, Technology, Finance, Compliance, Client Success, and operational teams to evaluate current performance, redesign workflows, establish accountability structures, and execute transformation initiatives that enable operational excellence. The ideal candidate is an experienced healthcare transformation with expertise in self-funded health plan administration, claims operations, stop-loss administration, business process redesign, technology enablement, operational analytics, and organizational change management. This individual must be comfortable operating as both a strategic transformation leader and a hands-on operator capable of driving measurable improvements across core TPA functions.

Responsibilities

Transformation Strategy & Future-State Design

Evaluate current-state claims and stop-loss capabilities, including processes, technology platforms, organizational structures, workflows, controls, compliance posture, and performance trends.
 Conduct structured assessments to identify operational gaps, root causes, scalability challenges, and improvement opportunities.
 Develop future-state operating models, transformation strategies, and implementation roadmaps aligned with Reflect Health’s long-term growth objectives.
 Establish transformation priorities, milestones, implementation plans, and success measures.
 Provide executive leadership with strategic recommendations, business cases, and investment priorities for transformation initiatives.
 Establish baseline KPIs, operating cadences, and accountability structures to measure transformation progress.

Business Process Transformation

  • Lead enterprise process redesign initiatives focused on simplifying workflows, reducing administrative complexity, improving operational scalability, and enhancing service performance.
  • Conduct process assessments, workflow analysis, process mapping, and root-cause evaluations to identify improvement opportunities. Establish transformation priorities, milestones, and implementation plans.
  • Redesign workflows and operating models to improve efficiency, quality, and consistency, as well as the development of standardized procedures, governance models, and operational accountability structures.
  • Facilitate cross-functional design sessions to develop sustainable future-state processes.

Claims & Stop-Loss Modernization

  • Lead modernization efforts across claims and stop-loss administration, including specific and aggregate claim processes, reporting workflows, filing timelines, and recovery processes
  • Evaluate end-to-end claims workflows, including intake, adjudication, payment, quality processes, and exception management, to identify opportunities for improvement.
  • Identify opportunities to reduce claims errors, rework, pend volume, manual intervention, and service-level misses.
  • Support initiatives that improve claims effectiveness, operational consistency, automation, and organizational readiness.
  • Partner with Operations leaders to improve claims quality frameworks, root-cause feedback loops, and continuous improvement practices.
  • Assess opportunities to improve plan configuration discipline, auto-adjudication rates, eligibility administration, and EDI processes.
  • Support automation opportunities for high-dollar claim identification, filing triggers, and exception management.

Technology Enablement & Automation

  • Partner with Technology teams to translate business opportunities into system enhancements, automation opportunities, platform improvements, and data-driven solutions.
  • Support evaluation of technology capabilities and recommend enhancements that enable future-state operations.
  • Identify opportunities for workflow automation, TPA platform optimization, EDI improvements, and operational enablement solutions.
  • Drive alignment between business strategy, operational needs, and technology investments.
  • Support development of operational dashboards and reporting capabilities that improve leadership visibility into performance trends, risks, and opportunities.

Transformation Governance & Measurement

  • Establish transformation governance frameworks, initiative tracking, executive reporting, and benefit realization processes.
  • Define transformation success measures related to claims performance, operational efficiency, stop-loss effectiveness, automation adoption, and service improvements.
  • Develop executive-level dashboards and communications related to transformation initiatives.
  • Provide leadership visibility into progress, risks, dependencies, and outcomes.

Change Management & Stakeholder Alignment

  • Lead organizational change efforts required to successfully implement new processes, technologies, and operating models.
  • Build alignment among teams, and facilitate communication, adoption planning, and organizational readiness activities.
  • Partner with operational leaders to ensure redesigned processes are successfully implemented and sustained.

Qualifications

Industry Experience

  • Significant leadership experience within a third-party administrator (TPA), self-funded health plan, managed care, or health insurance organization.
  • Deep understanding of claims operations, stop-loss administration, employer-sponsored health plans, and healthcare administration workflows.
  • Experience with self-funded plan mechanics, ASO arrangements, stop-loss contract structures, and carrier relationships preferred.
  • Knowledge of employer group, broker, TPA, and stop-loss carrier dynamics.

Transformation Leadership

  • Demonstrated success leading healthcare transformation initiatives, business process redesign, operational modernization, and enterprise change programs.
  • Experience developing future-state operating models, transformation roadmaps, and scalable operating processes.
  • Proven ability to identify operational gaps, define improvement opportunities, and drive implementation across organizational boundaries.
  • Ability to influence executive stakeholders and lead complex initiatives involving multiple business functions.

Process & Technology Expertise

  • Experience partnering with Technology teams to implement workflow automation, platform enhancements, data improvements, and operational enablement solutions.
  • Strong understanding of healthcare administration systems, EDI transactions, claims workflows, and operational processes.
  • Experience leveraging operational data, reporting tools, and analytics to identify root causes and support business decisions.
  • Familiarity with claims technology platforms, workflow tools, automation solutions, and operational reporting capabilities.

Claims & Stop-Loss Expertise

  • Experience improving claims accuracy, workflow efficiency, operational performance, and service-level outcomes.
  • Understanding of stop-loss administration processes, including specific and aggregate claims, filing requirements, recoveries, and carrier coordination.
  • Familiarity with healthcare compliance requirements, including No Surprises Act, ACA reporting, and Continuity of Care requirements preferred.

Leadership & Communication

  • Strong analytical, strategic thinking, and problem-solving capabilities. 
  • Excellent communication and stakeholder management skills.
  • Ability to translate complex operational challenges into actionable transformation strategies.
  • Ability to operate effectively in environments requiring cross-functional influence, organizational change, and continuous improvement.

Reflect Health is committed to providing a safe and secure workplace for all employees. All final candidates will be subject to background checks and drug screening as part of the hiring process.