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Claims Adjudicator Jobs (NOW HIRING)

Independent Health

Claims Adjudicator

Buffalo, NY · On-site

$18/hr

Overview The Claims Adjudicator is responsible for adjudicating and adjusting medical and/or dental claims against established criteria, and in accordance with specific clients SPD's maintaining ...

Diverse Lynx

Claims Adjudicator

$19/hr

Claims Adjudication: Review, verify, and process medical claims from start to finish, ensuring compliance with company policies and benefit guidelines. * Documentation Analysis: Evaluate claim ...

UNITE HERE HEALTH

Claims Adjudicator III

Oak Brook, IL · On-site

$23.79 - $29.13/hr

The Claims Adjudicator Level III ensures claims are processed accurately according to the benefits as defined in the various Plan Documents. This position supports the team Supervisor in meeting ...

Naphcare, Inc.

Senior Claims Adjudicator

Birmingham, AL · On-site

Overview NaphCare is hiring an experienced Senior Claims Adjudicator just like you to join our team at our Corporate Office in Birmingham, AL This is an on-site position. NaphCare is a family owned ...

Maine

Disability Claims Adjudicator

Winthrop, ME · Hybrid

$54K - $76K/yr

As a Disability Claims Adjudicator, you request and research prior medical records, collaborate with in-house Doctors and Psychologists around functional limitations, conduct vocational work analyses ...

UNITE HERE HEALTH

Claims Adjudicator II

Oak Brook, IL · On-site

$20.36 - $24.97/hr

The Claims Adjudicator II position will receive, examine, verify and input submitted claim data, determine eligibility status, and review and adjudicate claims within established timeframes. This ...

NaphCare

Senior Claims Adjudicator

Birmingham, AL

Overview NaphCare is hiring an experienced Senior Claims Adjudicator just like you to join our team at our Corporate Office in Birmingham, AL This is an on-site position. NaphCare is a family owned ...

NaphCare

Senior Claims Adjudicator

Vestavia Hills, AL · On-site

Overview NaphCare is hiring an experienced Senior Claims Adjudicator just like you to join our team at our Corporate Office in Birmingham, AL This is an on-site position. NaphCare is a family owned ...

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How much do claims adjudicator jobs pay per hour?

As of Jul 15, 2026, the average hourly pay for claims adjudicator in the United States is $26.74, according to ZipRecruiter salary data. Most workers in this role earn between $22.60 and $30.29 per hour, depending on experience, location, and employer.

What are some common challenges faced by Claims Adjudicators, and how can they be effectively managed?

Claims Adjudicators often encounter challenges such as managing a high volume of claims, interpreting complex policy details, and ensuring accuracy under tight deadlines. To effectively manage these, it's important to develop strong organizational skills, maintain up-to-date knowledge of insurance regulations, and use available adjudication software efficiently. Collaborating closely with other departments, such as customer service and medical review teams, also helps resolve ambiguous cases and ensures thorough, fair evaluations. Continuous training and open communication with supervisors can further support success in this role.

What Is a Claims Adjudicator?

A claims adjudicator determines how much money will be paid after an insurance claim has been examined. Their duties include sorting through the research and interviews for each claim, and deciding the amount of cash settlement. A claims adjudicator examines many types of insurance policy claims, including medical, disability, and social security claims. This job requires knowledge of the insurance industry. Supervised on-the-job training is provided in entry-level roles. Additional qualifications for the career are strong analytical, communication, and organizational skills.

What is the difference between Claims Adjudicator vs Claims Processor?

AspectClaims AdjudicatorClaims Processor
CredentialsHigh school diploma or equivalent; some roles may require insurance certificationsHigh school diploma or equivalent; minimal certifications often sufficient
Work EnvironmentOffice setting, insurance companies, healthcare organizationsOffice setting, insurance companies, healthcare organizations
Job FocusAnalyzing and evaluating insurance claims for accuracy and coverageProcessing claims, data entry, and basic claim handling
Common UsageInsurance industry, healthcare providersInsurance industry, healthcare providers

While both Claims Adjudicators and Claims Processors work within the insurance industry, Claims Adjudicators focus on evaluating and approving claims based on policy coverage, whereas Claims Processors handle the initial data entry and basic processing tasks. Understanding these differences helps job seekers identify roles that match their skills and career goals.

What are the key skills and qualifications needed to thrive as a Claims Adjudicator, and why are they important?

To excel as a Claims Adjudicator, you need strong analytical skills, attention to detail, and a solid understanding of insurance policies and regulations, often supported by relevant experience or a degree in business, finance, or a related field. Familiarity with claims management systems, insurance software, and sometimes certifications such as AIC (Associate in Claims) are commonly required. Excellent communication, problem-solving abilities, and integrity help you handle sensitive information and interact effectively with clients and colleagues. These skills ensure accurate, timely claim decisions and maintain trust with policyholders and insurers.

What does a Claims Adjudicator do?

A Claims Adjudicator is responsible for reviewing and processing insurance claims to determine whether they should be approved, denied, or adjusted. They examine documentation provided by claimants, healthcare providers, or other parties to ensure claims comply with policy terms and regulatory guidelines. Claims adjudicators may also communicate with claimants and providers to gather additional information, resolve discrepancies, and explain decisions. Their work helps ensure that claims are handled accurately and efficiently, protecting both the insurance company and the policyholder.
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Claims Adjudicator jobs near you
Infographic showing various Claims Adjudicator job openings in the United States as of July 2026, with employment types broken down into 6% Locum Tenens, 13% Internship, 40% As Needed, 23% Full Time, 2% Part Time, and 16% Nights. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution, with an average salary of $55,623 per year, or $26.7 per hour.

Claims Adjudicator

National Healthcare Solutions Group, Inc.

Miami, FL • On-site

Other

Medical

Posted 28 days ago

Job description

Claims Adjudicator

The Claims Adjudicator is responsible for reviewing, analyzing, and processing health insurance claims in accordance with established guidelines, contractual benefits and terms, and regulatory requirements. The claims adjudicator ensures that all claims are handled accurately, efficiently, and within specified timeframes, contributing to the overall effectiveness of the claims processing team. This role requires a detailed-oriented professional with a strong ability to follow instructions and a proactive approach to identifying and resolving discrepancies.

Essential Functions
  • Ensure all claims are processed in strict accordance with established guidelines and instructions.
  • Review and adjudicate claims in accordance with policy benefits.
  • Send claims for coverage analysis to the medical department in specific cases.
  • Regularly generate and analyze claims processing reports to identify discrepancies and ensure data accuracy.
  • Properly code procedures and diagnostics (CPT and ICD 10 coding)
  • Verify banking information.
  • Validate prescription medicines to the corresponding patient diagnosis.
  • Verify expenses with the renewal date for coverage.
  • Calculate expenses and deductible per policy year.
  • Verify waiting periods.
  • Verify pre-existing conditions and exclusions; deductible increases
  • Verify dates of service.
  • Verify currency conversions.
  • Verify general benefits of the policy according to the contracted plan.
Minimum Qualifications
  • Minimum 2 years' experience.
  • Bilingual (Spanish or Portuguese).
  • Experience in quality customer service.
  • General knowledge and proper management of Microsoft Office
  • Proactively identify discrepancies in claims; monitor claims patterns to identify opportunities for improvement.
  • Ability to work under pressure.
  • Ability to manage interpersonal relationships.
  • Effective oral and written communication skills.
  • Strong ability to follow detailed procedures and instructions with precision to ensure accurate and compliant claims adjudication.
Working Conditions

The following job-related working conditions are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.

Work Environment

The role primarily operates in an in-door, climate-controlled office setting working in close proximity to others. Noise level in the work environment is low to moderate. Light level provides adequate brightness for reading, computer work, and other tasks without causing glare or strain.

Physical Demands

The job primarily involves sedentary work with prolonged periods sitting at a desk. While performing the duties of this job, employees may occasionally be expected to:

  • exert up to 10 pounds of force and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
  • operate standard office equipment such as copiers, computers, telephones, printers, etc.
Travel Requirements

Minimal to no travel required

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