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Claims Adjudication Analyst Jobs (NOW HIRING)

Solis Health Plans

Benefits Analyst

Doral, FL · On-site

$60K - $70K/yr

Configure annual and ongoing benefit updates in claims adjudication and benefits administration ... Analyze benefit design changes and their downstream impact on claims processing and member ...

Solis Health Plans

NY · On-site

$60K - $70K/yr

Configure annual and ongoing benefit updates in claims adjudication and benefits administration ... Analyze benefit design changes and their downstream impact on claims processing and member ...

SIHO HOLDING INC

Claims Analyst

Columbus, IN

Job Title: Claims Analyst Reports To: Supervisor of Claims This is a non-exempt position ... Ensure timely and accurate claims adjudication * Follow company guidelines and policies for ...

Solis Health Plans, Inc.

NY · On-site

$60K - $70K/yr

Configure annual and ongoing benefit updates in claims adjudication and benefits administration ... Analyze benefit design changes and their downstream impact on claims processing and member ...

Solis Health Plans, Inc.

$60K - $70K/yr

Configure annual and ongoing benefit updates in claims adjudication and benefits administration ... Analyze benefit design changes and their downstream impact on claims processing and member ...

System One

Healthcare EDI Claims Analyst

Columbia, MD · On-site

$52.96/hr

Healthcare EDI Claims Analyst Location: Hybrid - Columbia/Baltimore, MD (2-3 days onsite per month ... Support claims adjudication and vouchering processes. * Document incidents, resolutions, and ...

SIHO HOLDING INC

Claims Analyst

Columbus, IN · On-site

Job Title: Claims Analyst Reports To: Supervisor of Claims This is a non-exempt position ... Ensure timely and accurate claims adjudication * Follow company guidelines and policies for ...

SIHO Insurance Services

Claims Analyst

Columbus, IN · On-site

Job Title: Claims Analyst Reports To: Supervisor of Claims This is a non-exempt position ... Ensure timely and accurate claims adjudication * Follow company guidelines and policies for ...

SIHO Insurance Services

Claims Analyst

Columbus, IN · On-site

Job Title: Claims Analyst Reports To: Supervisor of Claims This is a non-exempt position ... Ensure timely and accurate claims adjudication * Follow company guidelines and policies for ...

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Claims Adjudication Analyst information

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$14

$27

$51

How much do claims adjudication analyst jobs pay per hour?

As of Sep 12, 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:

Pharmacy Claims Adjudication Specialist

New Hyde Park, NY • On-site

Onco360
Health Care and Social Assistance • 501 - 1,000 employees
Learn more about Onco360external

$26/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

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

Key responsibilities

  • Adjudicates pharmacy claims and reviews claim responses for accuracy.

  • Contacts insurance companies to resolve third-party rejections and ensures timely medication shipments.

  • Serves as a customer service liaison to patients regarding financial responsibility and collects payments if applicable.

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in New Hyde Park, NY. This will be a Full-Time position. This position must be located within driving distance to our pharmacy, with a hybrid work style.
Shift times are between 8am and 8pm.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
Starting salary from $26.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before October 31st, 2026.
We offer a variety of benefits including:
  • Medical; Dental; Vision
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Company paid benefits – life; and short and long-term disability
Pharmacy Adjudication Specialist Major Responsibilities:
The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections
Pharmacy Adjudication Specialists at Onco360...
  • Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
  • Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
  • Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
  • Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
  • Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
  • Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
  • Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
  • Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
  • Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
  • Documents and submit requests for Patient Refunds when appropriate.
  • Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
  • Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
  • Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Pharmacy Adjudication Specialist Qualifications and Responsibilities...
  • Education/Learning Experience
    • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
    • Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
  • Work Experience
    • Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
    • Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
  • Skills/Knowledge
    • Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
    • Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
  • Licenses/Certifications
    • Required: Registration with Board of Pharmacy as required by state law
    • Desired: Certified Pharmacy Technician (PTCB)
  • Behavior Competencies
    • Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills
#Company Values: Teamwork, Respect, Integrity, Passion

What Onco360 employees say

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