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 ...
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 ...
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 ...
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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 ...
Pharmacy Claims Adjudication Specialist
Scottsdale, AZ ยท Remote
$23/hr
This is a remote hybrid opportunity, after onsite training period. Shift time currently available ... The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for ...
Pharmacy Claims Adjudication Specialist
Scottsdale, AZ ยท Remote
$23/hr
This is a remote hybrid opportunity, after onsite training period. Shift time currently available ... The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for ...
Pharmacy Claims Adjudication Specialist
Scottsdale, AZ ยท Remote
$23/hr
This is a remote hybrid opportunity, after onsite training period. Shift time currently available ... The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for ...
Pharmacy Claims Adjudication Specialist
Scottsdale, AZ ยท Remote
$23/hr
This is a remote hybrid opportunity, after onsite training period. Shift time currently available ... The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for ...
Product Manager, Claim Adjudication, Medicaid/Medicare
$85K - $104K/yr
The Claims Adjudication Product Manager (CAPM) is responsible for ensuring Med D, Medicaid, and ... Address Remote Location : Country US
Product Manager, Claim Adjudication, Medicaid/Medicare
$85K - $104K/yr
The Claims Adjudication Product Manager (CAPM) is responsible for ensuring Med D, Medicaid, and ... Address Remote Location : Country US
Claims Adjudicator
$18.27 - $25.72/hr
Our Investment in You: ยท Full-time remote work ยท Competitive salaries ยท Excellent benefits Key ... adjudication. ยท Alerts claims management to claims aging issues as well as provider billing ...
Claims Adjudicator
$18.27 - $25.72/hr
Our Investment in You: ยท Full-time remote work ยท Competitive salaries ยท Excellent benefits Key ... adjudication. ยท Alerts claims management to claims aging issues as well as provider billing ...
Claims Examiner - Remote
Tampa, FL ยท Remote
Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid trainingto set you up for success * Comprehensive ...
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Claims Examiner - Remote
Tampa, FL ยท Remote
Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid trainingto set you up for success * Comprehensive ...
Claims Examiner - Remote
Tampa, FL ยท Remote
Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid trainingto set you up for success * Comprehensive ...
Claims Examiner - Remote
Tampa, FL ยท Remote
Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid trainingto set you up for success * Comprehensive ...
Claims Examiner - Remote
Tampa, FL ยท Remote
Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid training to set you up for success * Comprehensive ...
Claims Examiner - Remote
Tampa, FL ยท Remote
Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid training to set you up for success * Comprehensive ...
Claims Examiner - Remote
Tampa, FL ยท On-site +1
Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid training to set you up for success * Comprehensive ...
Claims Examiner - Remote
Tampa, FL ยท On-site +1
Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid training to set you up for success * Comprehensive ...
Claims Quality Auditor - Remote
Tampa, FL ยท Remote
Remote Reports to: Claims Supervisor Position Summary: TheClaims Quality Auditor plays a key role ... Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS ...
Claims Quality Auditor - Remote
Tampa, FL ยท Remote
Remote Reports to: Claims Supervisor Position Summary: TheClaims Quality Auditor plays a key role ... Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS ...
Claims Quality Auditor - Remote
Tampa, FL ยท Remote
Remote Reports to: Claims Supervisor Position Summary: TheClaims Quality Auditor plays a key role ... Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS ...
Quick apply
Claims Quality Auditor - Remote
Tampa, FL ยท Remote
Remote Reports to: Claims Supervisor Position Summary: TheClaims Quality Auditor plays a key role ... Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS ...
Claims Examiner
Sherman Oaks, CA ยท Remote
$20 - $25/hr
Wellness resources Summary The claims examiner is responsible for the adjudication of claims, in ... remote position.
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Claims Examiner
Sherman Oaks, CA ยท Remote
$20 - $25/hr
Wellness resources Summary The claims examiner is responsible for the adjudication of claims, in ... remote position.
Hospital Claims Examiner
Sherman Oaks, CA ยท Remote
$21 - $24/hr
Wellness resources The claims examiner is responsible for the adjudication of claims, in accordance ... remote position.
Quick apply
Hospital Claims Examiner
Sherman Oaks, CA ยท Remote
$21 - $24/hr
Wellness resources The claims examiner is responsible for the adjudication of claims, in accordance ... remote position.
Claims Specialist II
NY ยท Remote
$55K - $60K/yr
This position has 4 weeks of virtual training followed by a hybrid or 100% remote work schedule ... Prior claims adjudication experience. * Active General Adjustor license for home state or ...
Claims Specialist II
NY ยท Remote
$55K - $60K/yr
This position has 4 weeks of virtual training followed by a hybrid or 100% remote work schedule ... Prior claims adjudication experience. * Active General Adjustor license for home state or ...
Adjudicator, Provider Claims - Remote Must reside in KY
Owensboro, KY ยท Remote
$15.58 - $31.97/hr
M-F 9:30am - 6pm Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring ...
Adjudicator, Provider Claims - Remote Must reside in KY
Owensboro, KY ยท Remote
$15.58 - $31.97/hr
M-F 9:30am - 6pm Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring ...
Adjudicator, Provider Claims - Remote Must reside in KY
Long Beach, CA ยท Remote
$15.58 - $31.97/hr
M-F 9:30am - 6pm Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring ...
Adjudicator, Provider Claims - Remote Must reside in KY
Long Beach, CA ยท Remote
$15.58 - $31.97/hr
M-F 9:30am - 6pm Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring ...
Adjudicator, Provider Claims - Remote Must reside in KY
Covington, KY ยท Remote
$15.58 - $31.97/hr
M-F 9:30am - 6pm Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring ...
Adjudicator, Provider Claims - Remote Must reside in KY
Covington, KY ยท Remote
$15.58 - $31.97/hr
M-F 9:30am - 6pm Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring ...
Adjudicator, Provider Claims - Remote Must reside in KY
Bowling Green, KY ยท Remote
$15.58 - $31.97/hr
M-F 9:30am - 6pm Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring ...
Adjudicator, Provider Claims - Remote Must reside in KY
Bowling Green, KY ยท Remote
$15.58 - $31.97/hr
M-F 9:30am - 6pm Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring ...
Adjudicator, Provider Claims - Remote Must reside in KY
Louisville, KY ยท Remote
$15.58 - $31.97/hr
M-F 9:30am - 6pm Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring ...
Adjudicator, Provider Claims - Remote Must reside in KY
Louisville, KY ยท Remote
$15.58 - $31.97/hr
M-F 9:30am - 6pm Job Summary Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring ...
Claims Adjudication Remote information
See salary details
$15.38 - $18.16
8% of jobs
$18.16 - $20.94
11% of jobs
$22.09 is the 25th percentile. Wages below this are outliers.
$20.94 - $23.71
13% of jobs
$23.71 - $26.49
17% of jobs
The median wage is $26.83 / hr.
$26.49 - $29.26
8% of jobs
$29.26 - $32.04
9% of jobs
$34.50 is the 75th percentile. Wages above this are outliers.
$32.04 - $34.81
9% of jobs
$34.81 - $37.59
9% of jobs
$37.59 - $40.36
3% of jobs
$40.36 - $43.14
5% of jobs
$43.14 - $45.91
6% of jobs
$15
$29
$45
How much do claims adjudication remote jobs pay per hour?
What are the key skills and qualifications needed to thrive as a Claims Adjudication Remote specialist, and why are they important?
What is claims adjudication in a remote job setting?
What are some common challenges faced by remote claims adjudicators, and how can they be effectively managed?

Full-time
Posted 8 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.