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Claims Adjudication Jobs (NOW HIRING)

Imagenet

Claims Adjudication Manager

Saint Louis, MO · Remote

Claims Adjudication Manager U.S.-Based Operational Leader Overseeing Philippines Claims Adjudication Work Setup: Remote Reports To: SVP Operations Direct Oversight: Philippines-based claims ...

Imagenet

Claims Adjudication Manager

Saint Louis, MO · On-site

Claims Adjudication Manager U.S.-Based Operational Leader Overseeing Philippines Claims Adjudication Work Setup: Remote Reports To: SVP Operations Direct Oversight: Philippines-based claims ...

MCI Careers

Claims Adjudication Specialist

Killeen, TX · On-site

$14/hr

We are seeking a detail-oriented and analytical On-Site Claims Adjudication Specialist to join our team! If you have strong critical thinking skills, a passion for exceptional customer service, and ...

MCI Careers

Claims Adjudication Specialist

Killeen, TX · On-site

$14/hr

We are seeking a detail-oriented and analytical On-Site Claims Adjudication Specialist to join our team! If you have strong critical thinking skills, a passion for exceptional customer service, and ...

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Claims Adjudication information

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How much do claims adjudication jobs pay per hour?

As of Jun 14, 2026, the average hourly pay for claims adjudication in the United States is $29.40, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $35.10 per hour, depending on experience, location, and employer.

What are the typical daily responsibilities of someone working in Claims Adjudication?

As a Claims Adjudication professional, your daily responsibilities generally include receiving and reviewing insurance claims, verifying information and supporting documentation, applying policy guidelines, and determining coverage eligibility or payment amounts. You may also be required to correspond with policyholders, medical providers, or other parties to gather additional information or clarify details. Regular collaboration with team members, supervisors, and other departments helps ensure consistency and accuracy in decision-making. Staying organized and managing multiple cases at various stages is essential for meeting deadlines and maintaining workflow efficiency.

What are the key skills and qualifications needed to thrive in the Claims Adjudication position, and why are they important?

To thrive in Claims Adjudication, a strong understanding of insurance policies, medical or legal terminology, and analytical skills is usually required, often supported by a degree in a relevant field or equivalent experience. Familiarity with claims management systems, databases, and software such as Microsoft Office or specialized adjudication platforms is essential. Attention to detail, problem-solving ability, and effective communication skills help professionals excel when reviewing claims and interacting with clients or team members. These competencies are critical to ensure accurate claim processing, compliance with regulations, and a high standard of customer service.

What does a claim adjudicator do?

A claims adjudicator reviews insurance claims to determine their validity and the amount payable based on policy coverage and guidelines. They analyze claim documentation, verify information, and make decisions to approve, deny, or request additional information, often using claims processing software. Attention to detail and knowledge of insurance policies are essential for this role.

What is a Claims Adjudication job?

A Claims Adjudication job involves reviewing and processing insurance claims to determine their validity and accuracy. Professionals in this role assess medical, health, or other types of claims based on policy terms, provider agreements, and regulatory guidelines. They verify documentation, check for errors, and decide whether to approve, deny, or request further information. Claims adjudicators ensure that payments are correctly calculated and comply with company policies. This role requires attention to detail, knowledge of industry regulations, and strong analytical skills.

How much does a claim adjudicator make?

A claims adjudicator typically earns between $40,000 and $70,000 annually, depending on experience, location, and employer. Entry-level positions may start lower, while experienced professionals or those in specialized settings can earn higher salaries. Certifications and familiarity with claims processing software can also influence compensation.

What jobs pay more than $300,000 a year?

In claims adjudication, senior roles such as Claims Director or Vice President can earn over $300,000 annually, especially with extensive experience, advanced certifications, and leadership responsibilities. High-level executive positions in insurance companies or health plans also often exceed this salary range. These roles typically require strong analytical skills, industry knowledge, and management experience.

What jobs pay 2000 a day?

Claims adjudication is typically a salaried role rather than a daily-paid position, with most professionals earning annual salaries rather than daily rates. High-paying jobs that can reach $2,000 a day often include specialized consulting, executive roles, or certain freelance professions requiring advanced skills and experience. Such earnings are usually associated with contract work or self-employment rather than standard employment in claims adjudication.
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What cities are hiring for Claims Adjudication jobs? Cities with the most Claims Adjudication job openings:
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Claims Adjudication jobs near you
Infographic showing various Claims Adjudication job openings in the United States as of June 2026, with employment types broken down into 100% Full Time. Highlights an 75% In-person, and 25% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.

Claims Adjudication Manager

Imagenet

Saint Louis, MO • Remote

Full-time

Posted 10 days ago

Job description

Claims Adjudication Manager

U.S.-Based Operational Leader Overseeing Philippines Claims Adjudication


Work Setup: Remote

Reports To: SVP Operations

Direct Oversight: Philippines-based claims adjudication team (examiners, auditors, team leads)

Hours: Pacific Time Zone: Core overlap with Philippines business hours required; evening calls for client/offshore alignment


Role Summary

Imagenet is seeking an experienced, U.S.-based Claims Adjudication Manager to provide hands-on operational leadership for a claims adjudication account, which is delivered through our wholly owned global delivery center in the Philippines. This is a player-coach role for a seasoned claims subject-matter expert (SME) who can bridge U.S. client expectations and offshore delivery - directly strengthening quality, throughput, reporting accuracy, and client-facing credibility.


The successful candidate combines deep adjudication expertise in both hospital (facility) and professional claims with proven experience leading and developing offshore claims teams. They will serve as the senior operational point of contact for the client, set the standard for adjudication accuracy, and build the coaching, audit, and documentation infrastructure needed to deliver consistent, high-quality outcomes at scale. They will not hesitate to role up their sleeves and dive into production and quality.


Key Responsibilities

Operational Leadership (Onshore Lead for Offshore Delivery)

  • Provide day-to-day operational leadership for the Philippines-based adjudication team (examiners, auditors, and team leads), working across time zones to direct priorities and remove blockers.
  • Serve as the hands-on claims SME for the campaign - personally adjudicating complex or escalated claims and modeling correct handling for the team.
  • Drive accuracy, productivity, quality, and service-level goals; translate client requirements into clear, executable operating procedures.
  • Partner with the offshore manager and team leads to strengthen communication, information flow, and consistency of execution.

Client Engagement & Single Point of Contact

  • Act as the senior operational single point of contact (SPOC) for the client, consolidating guidance from multiple client stakeholders into one consistent set of directives for the delivery team.
  • Lead client working sessions, escalations, and operational updates with confidence and credibility; provide clear written and verbal updates on performance, quality, and improvement actions.
  • Manage frequently changing client requirements - capturing, sequencing, and operationalizing new directives without disrupting production.

Quality, Coaching & Audit

  • Own the quality program: reduce repeat errors, identify root causes, and close coaching gaps through targeted, SME-led feedback.
  • Align coaching responsibilities with subject-matter expertise; design and lead calibration sessions between examiners and auditors.
  • Assess auditor capability and set audit-throughput targets that balance thoroughness with release timelines.

Reporting & Production Validation

  • Oversee validation of production reporting; partner with the business analyst and client to resolve reporting discrepancies (e.g., over- or under-counting) and establish a trusted tracking methodology.
  • Use data to identify capacity, monitor service levels, and demonstrate measurable improvement to the client.

Documentation & Knowledge Management

  • Establish and maintain a centralized documentation and knowledge-management process for client directives, reducing reliance on individual knowledge.
  • Ensure source documentation is centralized and current so that AI-assisted retrieval and other enablement tools deliver reliable answers.

Workforce & Cross-Functional Collaboration

  • Partner with HR and recruiting to accelerate hiring, rebuild the candidate pipeline, and stabilize staffing levels.
  • Collaborate with QA, training, workforce management, infrastructure/IT (including connectivity and latency monitoring for remote staff), and client services to support execution.
  • Coordinate with consultants, business analysts, and transition partners during onboarding and ramp activities.


Must-Have Qualifications

  • 6+ years of U.S. healthcare claims adjudication experience, with hands-on expertise in BOTH hospital/facility (UB-04) and professional (CMS-1500/HCFA) claims.
  • 3+ years leading claims teams (managing 30-40+ examiners/auditors, directly or through team leads), ideally including offshore or BPO/shared-services teams.
  • Demonstrated ability to serve as a client-facing operational leader - running working sessions, owning escalations, and building client trust.
  • Strong command of claims workflows, medical terminology, coding concepts, benefits, and payer/provider processes.
  • Proven track record managing productivity, quality, service levels, and team performance in a metrics-driven environment.
  • Experience coaching examiners and reducing error rates through structured quality and calibration programs.
  • Excellent written and verbal communication; able to work effectively across cultures and time zones.
  • Strong analytical and problem-solving skills, including working with production and quality data.


Preferred Qualifications

  • Experience overseeing or supporting Philippines-based or other offshore healthcare claims operations.
  • Experience supporting U.S. health plans, TPAs, healthcare BPOs, or shared-services operations.
  • Exposure to payment review, denials, appeals, or related claims functions.
  • Experience building documentation/SOP libraries and knowledge-management processes.
  • Exposure to process improvement, automation, or digital-transformation initiatives (including AI-assisted enablement tools).
  • Familiarity with claims platforms and reporting validation.


Key Competencies

  • Hands-on claims adjudication expertise (hospital + professional)
  • Operational leadership of distributed / offshore teams
  • Client and stakeholder communication; single point of contact
  • Quality, coaching, and audit calibration
  • Analytical thinking, reporting validation, and problem-solving
  • Continuous improvement and cross-functional collaboration


Company Overview

Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services - including digital transformation, claims adjudication, and member and provider engagement services - acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with their members and providers.


The company currently serves over 70 health plans, processing millions of claims and the related structured and unstructured data elements within those claims annually. Imagenet has also developed an innovative workflow technology platform, JetStream, to support traceability, governance, and automation of claims operations for its clients.


Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S., and has a wholly owned global delivery center in the Philippines.

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