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Disability Claims Adjudicator Jobs (NOW HIRING)

Onco360

$21/hr

Company paid benefits - life; and short and long-term disability Pharmacy Adjudication Specialist Major Responsibilities: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review ...

Pacificlife

Sr. Short Term Disability Specialist-1

As a Senior Claims Specialist - Short Term Disability, you'll move Pacific Life, and your career, forward by leading the end-to-end adjudication of complex Short Term Disability claims, partnering ...

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How much do disability claims adjudicator jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for disability 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 is a disability claims adjudicator?

A Disability Claims Adjudicator is responsible for reviewing and evaluating disability claims to determine eligibility for benefits. They analyze medical records, work history, and relevant regulations to make fair and accurate decisions. This role requires strong analytical skills, attention to detail, and knowledge of disability laws and guidelines. Adjudicators may work for government agencies, insurance companies, or private organizations handling disability claims.

What are the key skills and qualifications needed to thrive as a disability claims adjudicator?

To thrive as a Disability Claims Adjudicator, you need strong analytical abilities, knowledge of disability laws and regulations, and experience in case management, often supported by a relevant degree or certification. Familiarity with claims processing software, electronic document management systems, and potentially legal or medical terminology databases is typically required. Attention to detail, effective communication, and empathy are crucial soft skills for interacting with claimants and collaborating with other professionals. These skills ensure that claims are accurately and fairly evaluated, leading to just outcomes and high-quality service delivery.

What are the main challenges faced by disability claims adjudicators in their day-to-day work?

Disability Claims Adjudicators often encounter challenges such as reviewing complex medical documentation, interpreting various laws and guidelines, and making impartial decisions under tight deadlines. Balancing empathy for claimants with strict adherence to policies can be demanding. The role may also require frequent collaboration with healthcare professionals, legal experts, and other adjudicators to ensure a thorough evaluation of claims. Successfully managing caseloads and prioritizing tasks are key to maintaining accuracy and timely outcomes. With strong analytical and organizational skills, many adjudicators find the position both challenging and rewarding.

How much does a disability claims adjudicator make?

A disability claims adjudicator typically earns a median annual salary of around $50,000 to $70,000, depending on experience, location, and the employing agency. Entry-level positions may start lower, while experienced adjudicators or those in higher-cost areas can earn more, often with benefits and opportunities for advancement.

How to become a disability claims adjudicator?

To become a disability claims adjudicator, candidates typically need a bachelor's degree in a relevant field such as social work, healthcare, or public administration. Relevant experience in claims processing, knowledge of disability policies, and strong analytical skills are also important; some positions may require certification or training provided by the employer or government agency.

What does a disability claims adjudicator do?

A disability claims adjudicator reviews and evaluates disability benefit claims to determine eligibility based on medical evidence, policy guidelines, and legal criteria. They analyze documentation, interview claimants, and make decisions or recommendations, often using specialized software and adhering to strict deadlines. Strong attention to detail and knowledge of disability policies are essential for this role.
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Disability Claims Adjudicator jobs near you
Infographic showing various Disability Claims Adjudicator job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 75% Full Time, 20% Part Time, 3% Contract, and 1% Nights. Highlights an 95% Physical, 2% Hybrid, and 3% Remote job distribution, with an average salary of $55,623 per year, or $26.7 per hour.

Pharmacy Claims Adjudication Specialist

Onco360

Louisville, KY

$21/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 25 days ago

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

20th of 113 rated pharmacies

Job description

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Louisville, KY. 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 currently 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 $21.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before September 30th, 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
#IH
Employment Type: Full Time

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