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Claim Adjudication Manager Jobs (NOW HIRING)

Cook Children's

Claim Auditor I

Fort Worth, TX · On-site

... Manager in a structured report format within required timelines. Results of the audits are to be ... Advanced knowledge of claim adjudication and benefit plan application for Medicaid and CHIP ...

Integrated Resources INC

Claims analyst

Omaha, NE · On-site

... claim adjudication process. (*) Coordinates responses for routine phone inquiries and written ... manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters ...

Cook Children's

... Manager in a structured report format within required timelines. Results of the audits are to be ... Advanced knowledge of claim adjudication and benefit plan application for Medicaid and CHIP ...

Cook Children's

Claim Auditor I

Fort Worth, TX · On-site

... Manager in a structured report format within required timelines. Results of the audits are to be ... Advanced knowledge of claim adjudication and benefit plan application for Medicaid and CHIP ...

CVS Health

Claim Benefit Specialist

$17 - $28.46/hr

Analyzes and approves routine claims that cannot be auto adjudicated. Applies medical necessity ... In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ...

UNITE HERE HEALTH

Claims Adjudicator II

Oak Brook, IL · On-site

$20.36 - $24.97/hr

... our participants in managing their own health and healthcare. Our vision is exciting and ... claim adjudication environment * Working knowledge and experience in interpretation of benefit ...

UNITE HERE HEALTH

Claims Adjudicator II

Oak Brook, IL · On-site

$20.36 - $24.97/hr

... our participants in managing their own health and healthcare. Our vision is exciting and ... claim adjudication environment * Working knowledge and experience in interpretation of benefit ...

CVS Health

Senior Claim Benefit Specialist - Remote

$18.50 - $42.35/hr

... claim adjudication. - Ensures compliance with all regulatory requirements and confirms that ... manage multiple assignments with accuracy, efficiency, and attention to detail. Preferred ...

Adecco

Stop Loss Claim Specialist

Fresno, CA · On-site

$19 - $21/hr

Ability to manage multiple priorities in a fast-paced environment. Preferred Qualifications * Experience reviewing medical records and claim adjudication. * Background in insurance verification or ...

Adecco

Stop Loss Claim Specialist

Fresno, CA

$19 - $21/hr

Ability to manage multiple priorities in a fast-paced environment. Preferred Qualifications * Experience reviewing medical records and claim adjudication. * Background in insurance verification or ...

Chubb

Claim Adjuster

Chicago, IL · On-site

Actively manage inventory and ongoing claim adjudication. * Effectively communicate with customers using empathy and professionalism via phone and written correspondence. * Interface with ...

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Claim Adjudication Manager information

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$35K

$87.9K

$139K

How much do claim adjudication manager jobs pay per year?

As of Sep 10, 2026, the average yearly pay for claim adjudication manager in the United States is $87,861.00, according to ZipRecruiter salary data. Most workers in this role earn between $68,000.00 and $105,000.00 per year, depending on experience, location, and employer.

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Infographic showing various Claim Adjudication Manager job openings in the United States as of August 2026, with employment types broken down into 88% Full Time, 11% Part Time, and 1% Contract. Highlights an 85% Physical, 2% Hybrid, and 13% Remote job distribution, with an average salary of $87,861 per year, or $42.2 per hour.

Claim Auditor I

Fort Worth, TX • On-site

Cook Children's Health Care System
Health Care and Social Assistance • 5 - 10K employees
Learn more about Cook Children's Health Care Systemexternal

Full-time

Re-posted 17 days ago

Cook Children's Health Care System rating

7.9

Company rating: 7.9 out of 10

Based on 78 frontline employees who took The Breakroom Quiz

Job description

Location:

Calmont Operations Building

Department:

Reimbursement Analysis

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

The Claim Auditor I is responsible for auditing behavioral and medical claims and ensuring quality metrics are met by conducting post claims reviews on posted claims for Texas Medicaid and CHIP programs. The Claim Auditor I is responsible for auditing a set claim sampling on a monthly basis of routine to moderate complexity which includes paper and electronic claims submission. The Claim Auditor I ensures that claims payment integrity aligns with regulatory standards, timelines, business policy, provider and HHSC contracts, appropriate coding and system configuration. Audit reports may include UB-1450 and HCFA CMS 1500 claim forms not limited to behavioral health, physician, Institutions for Mental Disease, hospital outpatient and inpatient, and long term services and support claims. The Claim auditor is also responsible for pre-auditing high dollar claims to ensure claim payment is accurate before releasing the claim for payment. The Claim Auditor I is also responsible for communicating audit results to the Reimbursement and Analysis Manager in a structured report format within required timelines. Results of the audits are to be communicated to the Claims Department. The individual in this position performs all job functions in accordance with HIPPA and security rules as it relates to protected health information and has a thorough understanding of claims life cycle.

Additional Information:

  • The Claim Auditor I is responsible for auditing behavioral and medical claims and ensuring quality metrics are met by conducting post claims reviews on posted claims for Texas Medicaid and CHIP programs. The Claim Auditor I is responsible for auditing a set claim sampling on a monthly basis of routine to moderate complexity which includes paper and electronic claims submission. The Claim Auditor I ensures that claims payment integrity aligns with regulatory standards, timelines, business policy, provider and HHSC contracts, appropriate coding and system configuration. Audit reports may include UB-1450 and HCFA CMS 1500 claim forms not limited to behavioral health, physician, Institutions for Mental Disease, hospital outpatient and inpatient, and long term services and support claims. The Claim auditor is also responsible for pre-auditing high dollar claims to ensure claim payment is accurate before releasing the claim for payment. The Claim Auditor I is also responsible for communicating audit results to the Reimbursement and Analysis Manager in a structured report format within required timelines. Results of the audits are to be communicated to the Claims Department. The individual in this position performs all job functions in accordance with HIPPA and security rules as it relates to protected health information and has a thorough understanding of claims life cycle.


Education:

  • Associates degree required or a minimum of 5 years of claims/audit experience which includes experience with federal programs (Medicaid, CHIP) or in a health plan/payor environment preferred. 7-10 years of medical claims processing, claim adjudication, coordination of benefit plan, medical terminology and coding.
  • Must have strong organizational skills, problem solving and decision-making skills. Advanced knowledge of claim adjudication and benefit plan application for Medicaid and CHIP programs.
  • Microsoft Office skills including Word, Excel and Access. Excellent customer service skills with ability to explain complicated benefit issues to staff and providers.

Certification/Licensure:

About Us:

Cook Children's Health Plan

Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise.

Cook Children's is an EOE/AA, Minority/Female/Disability/Veteran employer.

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About Cook Children's Health Care System

Sourced by ZipRecruiter

Cook Children's Health Care System, based in Fort Worth, Texas, operates in the healthcare industry with a primary focus on pediatric health services. Established in 1918, the system has been committed to improving the health of children through the prevention and treatment of childhood diseases. This integrated pediatric healthcare system includes a medical center, physician network, home health company, research institute, and a health plan. At the core of its operations is the mission to 'Improve the Health of Every Child' in its community, reflecting its commitment to providing quality care, research, education, and prevention and wellness services.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Fort Worth, TX, US

Year founded

1918

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