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Claim Adjudication Jobs (NOW HIRING)

Integrated Resources INC

Claims analyst

Omaha, NE · On-site

... claim adjudication process. (*) Coordinates responses for routine phone inquiries and written correspondence related to claim processing issues. Routes and triages complex claims to Senior Claim ...

Winston Staffing Services

Be Seen First

Claim Specialist

Jericho, NY · On-site

$27 - $28/hr

Key Responsibilities 1. Claim Resolution ... Adjudication: Independently and accurately adjudicate appeals and disputes for medical claims ...

CAPTRUE BENEFITS LLC

Claims Analyst

Minneapolis, MN · On-site

$52K - $62K/yr

Minimum 4+ years of medical claim adjudication or related experience * In-depth knowledge of health plans/benefits, TPA/self-funding processes, medical terminology and professional/institutional ...

Fortegra

Claims Examiner, Credit

Jacksonville, FL · On-site

Balance claim adjudication responsibilities with inbound customer service support based on business needs, handling approximately 40-60 inbound calls on designated call days. * Provide professional ...

CVS Health

Senior Claim Benefit Specialist - Remote

$18.50 - $42.35/hr

... claim adjudication. - Ensures compliance with all regulatory requirements and confirms that ... payments align with company policies and procedures. - Identifies and reports potential ...

Parkland Health

Must understand managed care and government payers' reimbursement principles, billing and claim adjudication processes. * Must be able to observe emerging trends and track them using analytics and ...

Apex Informatics

Data Analyst

Mason, OH · On-site

Experience understanding claim adjudication for member and provider reimbursements. * Experience with Facets platform using Claims, Provider, Network, Product Benefit Configuration * Knowledge of ...

VIS IT Solutions Inc

Synon Developer

Dulles, VA · Remote

Remote From prototype to real-world impact - be part of a global shift by doing work that matters. - Candidate will work on RxCLAIM/Claim Adjudication enhancement projects which involve changes to ...

VIS IT Solutions Inc

SYNON Developer

Dulles, VA · Remote

Remote From prototype to real-world impact - be part of a global shift by doing work that matters. - Candidate will work on RxCLAIM/Claim Adjudication enhancement projects which involve changes to ...

VIS IT Solutions Inc

SYNON Developer

Dulles, VA · On-site

Remote From prototype to real-world impact - be part of a global shift by doing work that matters. - Candidate will work on RxCLAIM/Claim Adjudication enhancement projects which involve changes to ...

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How much do claim adjudication jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for claim adjudication in the United States is $21.05, according to ZipRecruiter salary data. Most workers in this role earn between $18.03 and $22.84 per hour, depending on experience, location, and employer.
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Claim Adjudication jobs near you
Infographic showing various Claim Adjudication job openings in the United States as of August 2026, with employment types broken down into 79% Full Time, 19% Part Time, and 2% Contract. Highlights an 81% Physical, 6% Hybrid, and 13% Remote job distribution, with an average salary of $43,783 per year, or $21 per hour.

Supervisor, Claim Adjudication Operations

Navitus Health Solutions, LLC

Remote

$63K - $76K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Navitus Health Solutions rating

7.0

Company rating: 7.0 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

268th of 495 rated business services

Job description

Company
Navitus
About Us
Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other.. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.
Pay Range
USD $63,927.28 - USD $76,900.12 /Yr.
STAR Bonus % (At Risk Maximum)
7.50 - Pharm, Supvr, AsMgr, SrCSEII, PrgMgr, SrPrgMgr, SrProdMgr
Work Schedule Description (e.g. M-F 8am to 5pm)
M-F 8am to 5pm
Remote Work Notification
ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.
Overview
Due to growth, we are adding a Supervisor, Claim Adjudication Operations to our team.
The Supervisor, Claim Adjudication Operations (CAO) ensures efforts are in alignment with the CAO team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members and pharmacies by accurately administering benefits. This role will plan, design, coordinate and align resources to support the daily activities of the team. The Supervisor, CAO role will work closely with their team to identify, recommend, develop, implement, support, and improve customer-focused solutions.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
  • Oversee roles within the Claim Adjudication Operations department to support accurate and timely configuration and data transfers of client hierarchy, benefits, and networks.
  • Provide superior customer service utilizing a high-touch, customer centric approach focused on collaboration and communication.
  • Outreach and collaborate with CAO customers/partners for day-to-day work and contribute to action plan creation.
  • Oversight of work on Kanban boards, meeting turnaround times and performance guarantees.
  • Run department Kanban board(s) and huddles, including sizing of work requests.
  • Resource assignment of day-to-day work, audits, and root cause analysis/CAP.
  • Perform 1:1s to elicit feedback from department associates, provide mentorship, discuss career development, address performance, and provide workload and project guidance.
  • Perform workforce management duties for direct reports, including, but not limited to, overtime needs, time out of the office and time tracking.
  • Apply soft skills toward team members and external stakeholders alike in understanding every point of view and coming to the table with good negotiation skills. Must have the ability to work with different personalities across all departments and understand their point of view to communicate accordingly.
  • Adhere to department level objectives to ensure alignment with division and company strategic initiatives.
  • Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
  • Other duties as assigned.

Qualifications
What our team expects from you?
  • Bachelor's degree or equivalent work experience is required.
  • 4 years of Navitus experience in an operations or leadership role, OR 4 years of external leadership experience, preferably with a strong background in operations, required.
  • Knowledge of one or more responsibilities as defined above is strongly preferred.
  • Professional PBM industry work experience is preferred.
  • Knowledge of applicable data privacy practices and laws is preferred.
  • Healthcare industry practices and HIPAA knowledge would be a plus.
  • Experience as a member of a multi-disciplinary team is a plus.
  • Understanding of human resource management principles, practices, and procedures would be a plus.
  • Participate in, adhere to, and support compliance program objectives
  • The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus?
  • Top of the industry benefits for Health, Dental, and Vision insurance
  • 20 days paid time off
  • 4 weeks paid parental leave
  • 9 paid holidays
  • 401K company match of up to 5% - No vesting requirement
  • Adoption Assistance Program
  • Flexible Spending Account
  • Educational Assistance Plan and Professional Membership assistance
  • Referral Bonus Program - up to $750!

#LI-Remote
Location : Address
Remote
Location : Country
US

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