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Claims Adjudication Jobs (NOW HIRING)

Judi Health

Claims Adjudication Associate

Charlotte, NC · On-site

$82K - $103K/yr

Judi Health is seeking a self-driven Claims Adjudication Associate to support the Medical claims adjudication workflow for JUDI Health, our enterprise health platform. In year one, this individual ...

Capital Rx

Claims Adjudication Associate

Charlotte, NC · On-site

$82K - $103K/yr

Judi Health is seeking a self-driven Claims Adjudication Associate to support the Medical claims adjudication workflow for JUDI Health, our enterprise health platform. In year one, this individual ...

Capital Rx

Claims Adjudication Associate

Charlotte, NC · On-site

$82K - $103K/yr

Judi Health is seeking a self-driven Claims Adjudication Associate to support the Medical claims adjudication workflow for JUDI Health, our enterprise health platform. In year one, this individual ...

Judi Health

Claims Adjudication Associate

Charlotte, NC · On-site

$82K - $103K/yr

Judi Health is seeking a self-driven Claims Adjudication Associate to support the Medical claims adjudication workflow for JUDI Health, our enterprise health platform. In year one, this individual ...

Judi Health

Claims Adjudication Associate

Charlotte, NC · Hybrid

$17.25 - $23.50/hr

Judi Health is seeking a self-driven Claims Adjudication Associate to support the Medical claims adjudication workflow for JUDI Health, our enterprise health platform. In year one, this individual ...

Onco360

$21/hr

The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of ...

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How much do claims adjudication jobs pay per hour?

As of Aug 25, 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 is claims adjudication?

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.

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 claims adjudication?

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.

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Claims Adjudication jobs near you
Infographic showing various Claims Adjudication job openings in the United States as of August 2026, with employment types broken down into 1% Internship, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 79% Physical, 5% Hybrid, and 16% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.

Claims Adjudication Associate

Charlotte, NC • On-site

Judi Health
See more jobs at Judi Healthexternal

$82K - $103K/yr

Full-time

Re-posted 15 days ago

Job description

About Judi Health
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.
Location: Hybrid 3 days in Charlotte office
Position Summary:
Judi Health is seeking a self-driven Claims Adjudication Associate to support the Medical claims adjudication workflow for JUDI Health, our enterprise health platform.
In year one, this individual will train on the JUDI Medical adjudication system. This individual will be responsible for maintaining the operational adjudication process, member, and provider escalated inquiry management, subrogation, stop-loss, recoupment and adjustment flows, and adhering to standard and contractual claims processing SLAs.
In year two, this individual will be responsible for managing and servicing new and existing clients of JUDI's Medical Claims Adjudication platform. This individual will be expected to maintain an in-depth understanding of the evolving capabilities of JUDI and our medical network support and client base. Exceptional communication skills and attention to detail are critical for communicating with internal and external stakeholders to build holistic support for medical claims processing.
Position Responsibilities:
  • Review, assess, and make decisions on medical claims submitted by networks, claimants, or other parties.
  • Provide support to Customer Care representatives in relation to claims and benefits questions from Members and Providers.
  • The Claims Adjudicator reviews the facts of each case and applies the applicable laws, regulations, and policy provisions to determine the appropriate claim outcome.
  • The Claims Adjudicator must be knowledgeable of the claims process, laws, and policies, as well as possess excellent communication skills and a commitment to providing outstanding customer service.
  • Manually adjudicate claims received via 837 EDI file, HIPAA 1500 or UB-04 forms, or direct member reimbursement submissions via superbill submission.
  • Adhere to standard SLA's regarding number or percentage of claims processed per day
  • Assist in management of claims related mail workflows including Appeals, subrogation, payments, and stop-loss.
  • Build and maintain trusting relationships with clients through superior customer service.
  • Assist in communications throughout the implementation process, including detailed and strategic guidance for adjudication infrastructure, processing, reporting, inquiry management, and complex claim situations/requests.
  • Proactively identify execution risks and mitigation strategies.
  • Identify and drive efficiencies to automate adjudication flows and reduce risk.
  • Certain times of year may require meeting participation, service support or other requirements outside of standard business hours, including weekends.
  • Responsible for adherence to the Judi Health Code of Conduct including reporting of noncompliance.

Minimum Qualifications:
  • Bachelors degree strongly preferred
  • Experience managing a team of direct reports
  • 1+ years of work experience at a health plan, claims adjudicator, or TPA
  • Well-versed in Benefit determinations
  • Well-versed in impact of claims processing and adjudication in regards to COB, Adjustments, Appeals, and member/provider inquiries
  • Act as a patient advocate, protecting privacy and confidentiality issues.
  • Track record of leading cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
  • Exceptional project / time management, prioritization, and organizational skills to ensure customer satisfaction
  • Ability to shift between competing priorities and meet organizational goals
  • Proficient in Microsoft office Suite and willing to adapt to software such as Jira, Miro, Confluence, Github, and AWS Redshift
  • Excellent verbal, written, interpersonal and presentation skills
  • Ability to work effectively with virtual teams

Preferred Qualifications:
  • Medicare/Medicaid experience preferred

Charlotte, NC Salary Range
$82,400-$103,000 USD
All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.

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