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Claims Adjudication Remote Jobs (NOW HIRING)

Imagenet

Claims Quality Analyst - Remote

Omaha, NE · On-site +1

Claims Quality Analyst | Remote Job Type: Full time Work Setup: Remote Reports to: Claims ... Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS ...

ImageNetLLC

Claims Quality Auditor - Remote

Tampa, FL · 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 ...

Imagenet

Claims Quality Auditor - Remote

Tampa, FL · 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 ...

Sedgwick

Liability Claims Team Lead | Remote

... Lead | Remote Are you looking for an opportunity to join a global industry leader where you can ... Provides technical/jurisdictional direction to examiner reports on claims adjudication. * Compiles ...

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Claims Adjudication Remote information

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How much do claims adjudication remote jobs pay per hour?

As of Jun 12, 2026, the average hourly pay for claims adjudication remote 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 key skills and qualifications needed to thrive as a Claims Adjudication Remote specialist, and why are they important?

To thrive as a Claims Adjudication Remote specialist, you need a solid understanding of insurance policies, medical terminology, and claims processing, often supported by a high school diploma or relevant experience. Familiarity with claims management software, electronic data interchange (EDI) systems, and occasionally industry certifications like AAPC or AHIMA is beneficial. Attention to detail, analytical thinking, and strong communication skills help ensure accuracy and effective collaboration with team members and clients. These skills are essential for timely and accurate claims processing, minimizing errors, and maintaining regulatory compliance in a remote work environment.

What is claims adjudication in a remote job setting?

Claims adjudication is the process of reviewing and processing insurance claims to determine their validity and the amount payable to policyholders. In a remote setting, claims adjudicators use specialized software and secure access to company databases to evaluate claims from home or another remote location. They verify the details of each claim, check compliance with policy terms, and communicate with clients or healthcare providers as needed. Remote claims adjudicators must be detail-oriented, have strong analytical skills, and maintain confidentiality while handling sensitive information.

What are some common challenges faced by remote claims adjudicators, and how can they be effectively managed?

Remote claims adjudicators often encounter challenges such as maintaining clear communication with team members, staying updated with frequently changing policies, and managing a high volume of complex cases independently. To manage these effectively, it's important to leverage collaboration tools, participate in regular virtual team meetings, and stay proactive in seeking clarification on policies or procedures. Additionally, strong organizational skills and self-discipline are crucial for meeting deadlines and maintaining accuracy in remote settings.
More about Claims Adjudication Remote jobs
What cities are hiring for Claims Adjudication Remote jobs? Cities with the most Claims Adjudication Remote job openings:
What are the most commonly searched types of Claims Adjudication jobs? The most popular types of Claims Adjudication jobs are:
What states have the most Claims Adjudication Remote jobs? States with the most job openings for Claims Adjudication Remote jobs include:
What job categories do people searching Claims Adjudication Remote jobs look for? The top searched job categories for Claims Adjudication Remote jobs are:
Claims Adjudication Remote jobs near you
Infographic showing various Claims Adjudication Remote job openings in the United States as of June 2026, with employment types broken down into 87% Full Time, and 13% Part Time. Highlights an 100% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.
Pharmacy Adjudication Specialist

Pharmacy Adjudication Specialist

CareMed Specialty Pharmacy

Scottsdale, AZ • Remote

$23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

Job description

We are seeking a Pharmacy Adjudication Specialist at our CareMed Specialty Pharmacy in Scottsdale, AZ. This will be a Full-Time position. This is a remote hybrid opportunity, after onsite training period.
Shift time currently available: 9:00 am-5:30 pm MST
Starting salary from $23.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before July 31, 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 CareMed...
  • 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: 1+ 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

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