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Claims Adjudication Analyst Jobs (NOW HIRING)

ConnectiveRx

$64K - $85K/yr

The Sr Analyst, Adjudication serves as a technical subject matter expert responsible for leading ... Knowledge of NCPDP claims processing, transaction analysis, and technical documentation ...

ConnectiveRx

Sr. Analyst, Adjudication

Whippany, NJ · On-site +1

$57K - $82K/yr

The Sr Analyst, Adjudication serves as a technical subject matter expert responsible for leading ... Knowledge of NCPDP claims processing, transaction analysis, and technical documentation ...

ConnectiveRx

Sr. Analyst, Adjudication

Whippany, NJ · On-site

$89K - $117K/yr

The Sr Analyst, Adjudication serves as a technical subject matter expert responsible for leading ... Knowledge of NCPDP claims processing, transaction analysis, and technical documentation ...

ConnectiveRx

Sr. Analyst, Adjudication

Whippany, NJ · On-site +1

$89K - $117K/yr

The Sr Analyst, Adjudication serves as a technical subject matter expert responsible for leading ... Knowledge of NCPDP claims processing, transaction analysis, and technical documentation ...

Careington

Claims Finance Manager

Frisco, TX · On-site

Analyze claims payment activity, funding, payment activity, adjudication outcomes, and reimbursement trends to ensure financial accuracy and integrity * Monitor claim costs, payment variances ...

Onco360

$21/hr

The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for ... analytical skills, Intermediate typing/keyboarding skills * Desired: Knowledge of Foundation ...

Independent Health

Claims Adjudicator

Buffalo, NY · On-site

$18/hr

Continually meet department performance measures as it relates to production, accuracy, knowledge of policy and procedure and timeliness of claims adjudication. * Analyze, identify and research, as ...

Onco360

$23/hr

The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for ... analytical skills, Intermediate typing/keyboarding skills * Desired: Knowledge of Foundation ...

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Claims Adjudication Analyst information

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How much do claims adjudication analyst jobs pay per hour?

As of Sep 10, 2026, the average hourly pay for claims adjudication analyst in the United States is $27.39, according to ZipRecruiter salary data. Most workers in this role earn between $20.19 and $31.49 per hour, depending on experience, location, and employer.

What is the difference between Claims Adjudication Analyst vs Claims Processing Specialist?

AspectClaims Adjudication AnalystClaims Processing Specialist
CredentialsTypically requires a high school diploma or associate degree; certifications like CPC or CPC-A are commonUsually requires a high school diploma; certifications are less common
Work EnvironmentOffice setting, analyzing claims, ensuring compliance, and resolving discrepanciesOffice setting, processing claims, data entry, and customer service
Employer & IndustryHealth insurance companies, healthcare providers, third-party administratorsHealth insurance companies, healthcare providers, billing companies

Claims Adjudication Analysts focus on reviewing and approving or denying claims based on policies and regulations, often involving detailed analysis. Claims Processing Specialists handle the initial data entry and processing of claims, ensuring accuracy and completeness. While both roles work within the claims department, the Analyst role emphasizes decision-making and compliance, whereas the Specialist role centers on processing and data management.

How much do claims adjudication analysts make in the US?

Claims adjudication analysts in the US typically earn a median annual salary of around $45,000 to $60,000, depending on experience, location, and employer. Entry-level positions may start lower, while experienced analysts or those with specialized skills can earn higher wages, often supplemented with benefits and opportunities for advancement.

Is claims adjudication analyst claims processing a stressful job?

Claims adjudication analysts often work in a fast-paced environment where accuracy and attention to detail are essential, which can lead to work-related stress. The job may involve managing high volumes of claims and meeting strict deadlines, but stress levels vary depending on workload, support systems, and individual coping skills.

What states have the most Claims Adjudication Analyst jobs?

States with the most job openings for Claims Adjudication Analyst jobs include:

What are popular job titles related to Claims Adjudication Analyst jobs?

For Claims Adjudication Analyst jobs, the most frequently searched job titles are:

Claims Adjudication Supervisor

Milford, OH • On-site

Tata Consultancy Services
IT Services • 10K+ employees
Learn more about Tata Consultancy Servicesexternal

Other

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

Key responsibilities

  • Supervise daily claims adjudication activities, work allocation, queue management, attendance, and operational coverage.

  • Lead and coach a team of claims professionals, monitor key performance metrics, and initiate recovery actions as needed.

  • Review and facilitate resolution of complex or escalated claims within defined authority.

Tata Consultancy Services rating

6.5

Company rating: 6.5 out of 10

Based on 21 frontline employees who took The Breakroom Quiz

Job description

The Claims Adjudication Supervisor leads day-to-day healthcare payer claims operations and a team of Claims Processors, Claims Examiners, and Senior Associates. The role is accountable for accurate and timely claim outcomes, disciplined inventory management, associate coaching, compliance, and achievement of client-defined productivity, quality, turnaround-time, and service-level expectations.

Key Responsibilities

  • Supervise daily claims adjudication activities, work allocation, queue management, attendance, and operational coverage.
  • Lead and coach a team of approximately 15-20 claims professionals, with the final span determined by process complexity and the approved operating model.
  • Monitor productivity, quality, turnaround time, backlog, aging, pends, rework, and priority inventory; initiate timely recovery actions where required.
  • Ensure accurate application of member eligibility, plan benefits, provider information, authorization and referral rules, coordination of benefits, pricing, coding logic, edits, and payer-specific procedures.
  • Review and facilitate resolution of complex or escalated claims, including high-dollar claims, adjustments, duplicate claims, provider disputes, reimbursement exceptions, and Medicare or Medicaid scenarios within defined authority.
  • Conduct daily huddles, one-to-one coaching, performance discussions, quality feedback, and refresher interventions.
  • Partner with Quality, Training, Workforce Management, SMEs, Technology, and Client teams to improve outcomes and sustain operational readiness.
  • Lead root cause analysis and corrective or preventive action plans for recurring errors, SLA misses, and control gaps.
  • Maintain complete operational records, claim notes, audit evidence, issue logs, and status reporting.
  • Support change implementation, new benefit or policy updates, system releases, and transition or ramp activities.
  • Promote a culture of ethics, inclusion, accountability, data privacy, and continuous improvement.

Required Qualifications

  • Bachelor's degree preferred, or an equivalent combination of education and relevant experience.
  • Five or more years of US healthcare payer claims processing or adjudication experience, including at least two years in a team lead or supervisory capacity.
  • Working experience with Commercial, Medicare Advantage, Medicaid, managed care, or employer-sponsored health plan claims.
  • Strong understanding of the end-to-end claims lifecycle, benefits, eligibility, provider data, authorization and referrals, denials, pends, adjustments, coordination of benefits, and reimbursement concepts.
  • Working knowledge of ICD-10, CPT, and HCPCS code sets and their use in claims operations; this role does not require clinical coding unless specified by the account.
  • Experience using a payer claims platform such as Facets, QNXT, HealthRules, NASCO, Amisys, or an equivalent enterprise claims system.
  • Demonstrated ability to manage production commitments while maintaining accuracy, compliance, documentation, and employee engagement.
  • Strong written and verbal communication, analytical problem-solving, stakeholder management, and coaching skills.
  • Ability to work from the Cincinnati area and support client-defined business hours, including schedule flexibility during transitions or peak periods.


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About Tata Consultancy Services

Sourced by ZipRecruiter

Tata Consultancy Services is an IT services, consulting and business solutions organization that delivers real results to global business, ensuring a level of certainty no other firm can match. TCS offers a consulting-led, integrated portfolio of IT, BPO, infrastructure, engineering, and assurance services. This is delivered through its unique Global Network Delivery Model™, recognized as the benchmark of excellence in software development. TCS delivers a level of certainty that no other firm can match--to our clients and to our employees. Come join us and experience certainty in your career. TCS a global Consulting and IT Services firm that is ranked in the top quartile by industry analysts. Our 2021 fiscal revenues topped $25 B and our market capitalization is over $170+B, yet we have a deep and large history of philanthropy and corporate social responsibility. Now approaching 600K of the best IT professionals and consultants, we are a trusted advisor, guiding our clients' enterprises through growth and transformation journeys - helping them to become agile, intelligent, automated and on the cloud. We are devoted to DEI and are recognized as a top employer and place to work.

Industry

It services

Company size

10,000+ Employees

Headquarters location

Edison, NJ, US

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