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Manager Adjudication Jobs in Georgia (NOW HIRING)

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Manager Adjudication information

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 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 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 the most commonly searched types of Adjudication jobs in Georgia? The most popular types of Adjudication jobs in Georgia are:
What are popular job titles related to Manager Adjudication jobs in Georgia? For Manager Adjudication jobs in Georgia, the most frequently searched job titles are:
What job categories do people searching Manager Adjudication jobs in Georgia look for? The top searched job categories for Manager Adjudication jobs in Georgia are:
What cities in Georgia are hiring for Manager Adjudication jobs? Cities in Georgia with the most Manager Adjudication job openings:
Infographic showing various Manager Adjudication job openings in Georgia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 85% In-person, and 15% Remote job distribution.

Medical Case Manager -- Case Adjudication Support & Member Services

Essential Healthcare Solutions LLC

Warner Robins, GA • On-site

Full-time

Posted 9 days ago


Job description

Program:HQ AFRC/SG Aeromedical Case Management Support (RFQ FA664326Q0004)

Location: HQ AFRC, Robins AFB, Warner Robins, GA (on-site)

Employment type: Full-time, non-exempt (SCA) — contingent on award

Labor category Medical Record Technician (Medical Case Manager)

Reports toLead Medical Case Manager / Focal Point (UHP)

POSITION SUMMARY

Essential Healthcare Solutions is supporting Unified Health Partners. This role processes high-volume aeromedical cases for HQ AFRC with a primary focus on preparing cases for provider adjudication, compiling final dispositions, and serving as the unit/member help desk. You confirm case files are complete and that provider statements match the case type and higher-level (e.g., PEB) requirements, compile final disposition packages and member mail-outs, and answer day-to-day questions from medical personnel across the force. You are cross-trained on all team functions and rotate to cover intake and data entry during surge.

KEY RESPONSIBILITIES

•Confirm all required data is included in case files for HQ AFRC provider adjudication; confirm provider statements match the case type and higher-level (e.g., PEB) requirements.

•Reference and apply general medical guidelines and standards used to adjudicate cases; obtain medical opinions/recommendations from professional medical personnel.

•Collect and compile data for final case disposition and member mail-out (~702 final disposition/mail-out actions per month).

•Provide day-to-day advice and assistance to medical personnel across 69 units and three numbered Air Forces; receive calls and return messages within 2 duty days.

•Communicate effectively with coworkers, leaders, commanders, first sergeants, MAJCOMs, and AFMEDCOM, and help resolve conflicts at different levels.

•Screen and route incoming/outgoing correspondence, materials, publications, regulations, and directives; escalate items needing government attention.

•Assist with disposition of LOD determinations and RILOs where applicable.

•Cross-cover intake, data entry, and system-of-record updates (AIMWTS, ECT, PEPP, MEDXS) as directed to balance workload.

REQUIRED QUALIFICATIONS

•Domain experience: Demonstrated experience processing and managing physical exams and medical standards — acquired through a military medical environment (e.g., USAF Physical Exam Standards / PES, aeromedical, or reserve medical unit) OR an equivalent civilian aeromedical, occupational health, or disability evaluation system (DES) environment.

•Regulatory knowledge: Working knowledge of medical standards for retention, flying classes, Line of Duty (LOD) determinations, and special operational duty for the USAF; familiarity with the Aeromedical Waiver Guide (AMWG) and the Medical Standards Directory (MSD), applicable AFIs, and 422/469 and DES processes (or the ability to rapidly acquire it).

•Medical literacy: Basic knowledge of anatomy, physiology, disorders of human body systems, and emergency medical care procedures; proficiency with medical terminology and ICD-10 coding, used accurately when documenting cases.

•Communication & administrative skills: Excellent oral and written communication; ability to translate complex medical/administrative instructions to service members at their comprehension level; project-management / workflow-tracking ability.

•Technical skills: Proficiency with Adobe PDF and Microsoft Office (Word, Excel, Outlook, PowerPoint); proficient typing on both QWERTY and 9-key/numeric pads.

•Baseline requirements: Able to work independently with strong time-management and prioritization skills; exceptional customer-service skills; fluent in reading, writing, speaking, and understanding English.

•Customer-facing strength: Strong interpersonal and de-escalation skills for a high-touch help-desk role; ability to communicate medical/administrative instructions clearly to members and units.

SYSTEMS YOU'LL USE (GOVERNMENT-PROVIDED ACCESS & TRAINING)

The Government furnishes access to all systems of record, the government-configured computer/network you will use, and system-specific training. You do not need to own, license, or bring these systems — access is granted after your Tier 1 background investigation clears. You must be proficient in, or able to rapidly acquire proficiency in:

•AIMWTS — Aeromedical Information Management Waiver Tracking System (waiver case documentation and routing).

•ECT — Electronic Case Tracking (AFRC case-management workflow / system of record).

•PEPP — Physical Examination Processing Program (exam ordering, processing, and closeout).

•MEDXS — Air Force medical readiness applications portal.

•JLV — Joint Longitudinal Viewer (read-only DoD/VA/community medical record viewer).

•MICT — Management Internal Control Toolset (self-assessment / compliance checklists).

•PHA — Periodic Health Assessment programs; plus Microsoft Office (Word, Excel, Outlook, PowerPoint) and Adobe PDF.

PREFERRED / HIGHLY DESIRED

•In-depth knowledge of Line of Duty (LOD) determinations and Medical Evaluation Board (MEB) processes.

•Prior hands-on experience in a USAF/AFRC/ARC aeromedical or reserve medical unit, or with the specific systems above (AIMWTS, ECT, PEPP) — clears the System-Experience gate with proof rather than crosswalk.

CLEARANCE & ONBOARDING REQUIREMENTS

•U.S. person / background investigation: Must be able to obtain and maintain a favorable Tier 1 (T1) National Agency Check with Inquiries (NACI). Tier 1 certification is required within 30 days of contract start; no network or system access is granted without a valid T1 or approved interim access. (Investigation cost is covered by the employer, not the candidate.)

•Non-Disclosure Agreement: Must sign the AFRC/SG Non-Disclosure Agreement prior to beginning performance.

•Required training: Must complete DoD Cyber Awareness, HIPAA, Privacy Act, and Derivative Classification training (government-provided).

WORK ENVIRONMENT & CONDITIONS

•Location: On-site at HQ Air Force Reserve Command, Robins Air Force Base (Warner Robins), GA. Single site; travel is not required. Relocation and travel are not reimbursed.

•Schedule: Full-time, normally 8 hours/day between 0800–1600 ET, Monday–Friday (core hours 0900–1500 ET), excluding federal holidays and Air Force Family/Down Days. Overtime is not authorized; flex-time is permitted to meet performance requirements.

•Telework: Situational telework only, with prior COR approval, using a government-approved VPN; sensitive data may not be stored on local/unapproved devices.

Non-personal services: This is a non-personal services contract. You are an employee of the contractor, take direction from and are supervised by the contractor (not the Government), and will identify yourself as contractor personnel at all times.

Compensation: Covered by the Service Contract Act, Wage Determination 2015-4495, labor category 12190 (Medical Record Technician). Base pay $21.48/hr (SCA minimum). Health & Welfare $5.55/hr. Non-exempt.