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Manager Adjudication Jobs in Ohio (NOW HIRING)

SRC, Inc.

Security Manager Specialist

Fairborn, OH · On-site

$110K - $126K/yr

SRC, Inc. is currently seeking an experienced Security Manager Specialist to provide personnel security (PERSEC) program management, adjudication support, and security operations oversight under the ...

Apogee Engineering, LLC

Program Manager

Dayton, OH · On-site

... SCI) adjudication Education: High School Diploma Years of Experience: 18+ years of experience ... Project Management Professional (PMP) certification (preferred) * Familiarity with ISR and ...

Apogee Engineering, LLC

Program Manager

Dayton, OH · Hybrid

... SCI) adjudication Education: High School Diploma Years of Experience: 18+ years of experience ... Project Management Professional (PMP) certification (preferred) * Familiarity with ISR and ...

Apogee Engineering, LLC

Program Manager

Dayton, OH · Hybrid

... SCI) adjudication Education: High School Diploma Years of Experience: 18+ years of experience ... Project Management Professional (PMP) certification (preferred) * Familiarity with ISR and ...

Apogee Engineering, LLC

Technical Program Manager

Dayton, OH · On-site

$121K - $157K/yr

... Information (SCI) adjudication Education: Master's degree Years of Experience: 9 years of ... Project Management Professional (PMP) certification (preferred) * Familiarity with ISR and ...

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All JobsAdjudication JobsManager Adjudication JobsManager Adjudication Jobs in Ohio

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 popular job titles related to Manager Adjudication jobs in Ohio?

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

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

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

What cities in Ohio are hiring for Manager Adjudication jobs?

Cities in Ohio with the most Manager Adjudication job openings:

Manager Adjudication jobs near you
Infographic showing various Manager Adjudication job openings in Ohio as of August 2026, with employment types broken down into 100% Full Time. Highlights an 85% In-person, and 15% Remote job distribution.

Adjudication Pharmacy Technician

Innovative Rx Us Holdings, Inc.

North Canton, OH • On-site

$15.50 - $19/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 24 days ago

Job description

Adjudication Pharmacy Technician

Finney's Institutional Pharmacy is seeking a motivated and customer-oriented individual to join our team as an Adjudication Pharmacy Technician. As a vital part of our adjudication team, you will be responsible for ensuring prescriptions are dispensed to eligible patients and billed properly in accordance with their benefit plan. Additionally, you will maintain a positive and pleasant demeanor with all customers and colleagues while accurately confirming eligibility and billing.

Responsibilities:
  • Perform billing duties as needed
  • Understand the pharmacy front-end process and perform point of sale functions (adjudication)
  • Contact payors and/or other outside agencies to verify information and resolve common, non-clinical problems
  • Run weekly billing reports
  • Obtain accurate billing and resident information, and rebill and resolve unpaid claims through adjudication
  • Re-bill and reconcile all incorrectly billed, non-clinical third-party denials
  • Identify and resolve and process denied claims in a timely manner
  • Document all communication concerning denied claims and any resolution communicated to facility or physicians
  • Obtain Prior Authorizations and non-covered forms
  • Obtain Part B documentation
  • Assist with billing DME supplies on line (Medicaid)
  • Resolve Hospice denials and communicate to Hospice nurses any denied claims
  • Adhere to and demonstrate mastery of current operating procedures
  • Use DocuTrack skills to locate specific documents and fax documents to facilities and/or for audit purposes
  • Stay in line with End of Month processes and deadlines
  • Ensure customer requests are handled quickly and professionally
  • Communicate effectively with customers to resolve billing inquiries
  • Communicate effectively with third party payors to resolve denied claims
  • Complete and verify pricing requests for customers
  • Direct specific inquiries to the appropriate team / individual
  • Maintain a positive, pleasant demeanor with all customers
  • Utilize robust problem-solving and people skills, patience, and telephone etiquette
  • Document customer issues using CPAS form and communicate to management
  • Work with Billing/Collection Managers on special projects as needed
  • Other duties as assigned
Qualifications:
  • Active pharmacy technician license from the Ohio State Board of Pharmacy preferred
  • Previous pharmacy experience extremely valuable and desired
  • At least 1 year of billing experience
  • Proficient in Microsoft word and Excel
Working Conditions:
  • Normal working hours: Monday through Friday, 8:30AM to 5:30PM, with additional time as required based on daily workloads.
  • This position may also include sitting for long periods of time.
  • Participation in the on-call rotation is voluntary, with incentive pay provided.
  • Adjudication team members must work well together as a team.
  • This position involves multiple hours of phone time per day speaking with Finney's doctors, leaders, administrators, and patients.
Physical Requirements:
  • This position requires sitting for extended periods of time.
  • Operating a desktop keyboard and mouse.
  • Communicating with employees, patients, caregivers, and physicians by phone, fax, and email in a courteous and professional manner.
We Proudly Offer:
  • (Primarily) Monday - Friday Day Shift
  • Closed for 6 Paid Holidays
  • 14 Days of PTO in the first year
  • Multiple Healthcare Plans
  • Dental and Vision Coverage
  • Free Life Insurance
  • Supplemental Insurance Plans
  • 401(k) Retirement Plan with a generous company match
  • Simple IRA
  • Medical and Dependent Care Flex Spending Accounts
  • $150 Initial Scrub Allowance, $50/year Continued Allowance

Join us at Finney's Institutional Pharmacy and become a valuable member of our dedicated team committed to providing exceptional customer service in the healthcare industry. Apply now and be part of our mission to make a difference in the lives of our patients and community.

EEOC Statement

We are an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

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