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Manager Adjudication Jobs in California (NOW HIRING)

LSMA Management Inc

Claims Manager

San Bernardino, CA · On-site

$87K - $97K/yr

... adjudication of professional and institutional claims in accordance with health plan contracts ... The Claims Manager monitors claims inventory, production, and quality metrics, ensures adherence to ...

LSMA Management Inc

Claims Manager

San Bernardino, CA · On-site

$87K - $97K/yr

... adjudication of professional and institutional claims in accordance with health plan contracts ... The Claims Manager monitors claims inventory, production, and quality metrics, ensures adherence to ...

LSMA Management Inc

Claims Manager

San Bernardino, CA · On-site

$87K - $97K/yr

... adjudication of professional and institutional claims in accordance with health plan contracts ... The Claims Manager monitors claims inventory, production, and quality metrics, ensures adherence to ...

HJ Staffing

QNXT Program Manager

Long Beach, CA · On-site +1

Coordinate alignment across Claims, Provider Data, Benefits, Utilization Management, and Capitation to ensure accurate future-state claims adjudication, pricing, and payment. * Vendor & Consultant ...

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All JobsAdjudication JobsManager Adjudication JobsManager Adjudication Jobs in California

Manager Adjudication information

What are the roles and responsibilities of a manager adjudication?

A Manager Adjudication oversees the process of reviewing and making decisions on claims, disputes, or applications, often within insurance, healthcare, or government sectors. Their responsibilities include managing a team of adjudicators, ensuring compliance with policies and regulations, reviewing complex cases, and implementing process improvements. They also provide training and support to staff, handle escalated cases, and work to streamline adjudication procedures for efficiency and fairness.

What are the key skills and qualifications needed to thrive as a manager adjudication?

To thrive as a Manager Adjudication, you need strong analytical skills, deep knowledge of claims processing, and typically a bachelor’s degree in business, healthcare administration, or a related field. Familiarity with adjudication software, claims management systems, and regulatory compliance tools is essential. Leadership, effective communication, and problem-solving abilities are crucial soft skills for managing teams and complex case reviews. These competencies ensure accurate, timely claims decisions and maintain compliance with industry standards, directly impacting organizational efficiency and client satisfaction.

What are some common challenges faced by a manager adjudication, and how can they be addressed?

A Manager Adjudication often faces challenges such as managing high volumes of complex cases, ensuring consistent and fair decision-making, and keeping up with changing regulations or organizational policies. Balancing efficiency while maintaining accuracy can be demanding, especially when deadlines are tight. These challenges can be addressed by implementing robust training programs for staff, leveraging technology for workflow management, and fostering clear communication within the team to ensure everyone is aligned on best practices and updates.

What is the difference between Manager Adjudication vs Claims Supervisor?

AspectManager AdjudicationClaims Supervisor
CredentialsTypically requires insurance or healthcare certifications, relevant degreesSimilar credentials, often with insurance or healthcare background
Work EnvironmentOffice-based, insurance or healthcare settingOffice-based, insurance or healthcare setting
Industry UsageCommon in insurance, healthcare, and claims processingCommon in insurance, healthcare, and claims departments
Primary FocusReviewing and approving claims, making adjudication decisionsOverseeing claims processing, managing claims staff

While both roles operate within the insurance and healthcare industries, the Manager Adjudication primarily focuses on reviewing and making decisions on claims, whereas the Claims Supervisor manages the claims team and oversees the claims process. Both roles require similar credentials and work environments, but their core responsibilities differ in scope and focus.

What are the most commonly searched types of Adjudication jobs in California?

The most popular types of Adjudication jobs in California are:

What are popular job titles related to Manager Adjudication jobs in California?

For Manager Adjudication jobs in California, the most frequently searched job titles are:

What job categories do people searching Manager Adjudication jobs in California look for?

The top searched job categories for Manager Adjudication jobs in California are:

What cities in California are hiring for Manager Adjudication jobs?

Cities in California with the most Manager Adjudication job openings:

Manager Adjudication jobs near you
Infographic showing various Manager Adjudication job openings in California as of August 2026, with employment types broken down into 100% Full Time. Highlights an 88% In-person, and 12% Remote job distribution.

Adjudication Lead - Roseville, CA (Hybrid)

Gainwell Technologies

Roseville, CA • Hybrid

$70K - $76K/yr

Full-time

Medical, Life, Retirement, PTO

Posted 8 days ago

Gainwell Technologies rating

7.8

Company rating: 7.8 out of 10

Based on 82 frontline employees who took The Breakroom Quiz

139th of 246 rated software companies

Job description

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

Your role in our mission
  • Answers questions from the claims adjudication team and responds to complex customer inquiries or routes them to the appropriate personnel.
  • Researches and responds to customer inquiries in a timely manner.
  • Processes requests and updates account history with proper documentation.
  • Processes and distributes incoming and outgoing work in accordance with service level agreements.
  • Performs data entry and matches documents to the appropriate accounts.Interfaces with team members, management, and customers regarding claim adjudication issues.
  • Reviews client reports daily to ensure data integrity and submits reports to management.
  • Recommends workflow and procedure improvements to support efficient transaction processing.
  • Monitors daily claims transactions to ensure compliance with policies, procedures, and service level agreements.
  • Assists with day-to-day claims adjudication operations, including training and mentoring less experienced staff.
What we're looking for
  • High school diploma or G.E.D. 
  • Three or more years of Claims, TARs, CIFs. NOAs, RTDs experience 
  • Experience working with organizational functions and personnel 
  • Experience working with, computer software, and CRM technology, and Mainframe 
  • Experience working with and skilled in the use of help desk software
What you should expect in this role
  • Remote hybrid work arrangement with 2 days per week in the Roseville, CA office, depending on business and client needs.
  • Monday through Friday schedule.
  • Up to 10% travel required.
 
This position will remain open for applications through September 10, 2026.

The pay range for this position is $70,304.00 - $76,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

What Gainwell Technologies employees say

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Benefits

Hours and flexibility

Workplace

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About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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