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Manager Adjudication Jobs (NOW HIRING)

Onco360

Supervisor - Pharmacy Adjudication

Buffalo, NY · On-site

$63 - $74.25/hr

We succeed when you do, and our company and management team work hard to foster an environment that ... Adjudication Supervisor Essential Functions: * Supervises adjudication staff in a leadership role ...

Capital Rx

Claims Adjudication Associate

Charlotte, NC · On-site

$17.25 - $23.50/hr

Judi Health , which offers full-service health benefit management solutions to employers, TPAs, and ... The Claims Adjudication Associate is responsible for evaluating claims submitted by policyholders ...

Onco360

Supervisor - Pharmacy Adjudication

Waltham, MA · On-site

$70 - $82.50/hr

We succeed when you do, and our company and management team work hard to foster an environment that ... Adjudication Supervisor Essential Functions: * Supervises adjudication staff in a leadership role ...

Capital Rx

Claims Adjudication Associate

Manhattan, NY · On-site

$19.50 - $26.50/hr

Judi Health , which offers full-service health benefit management solutions to employers, TPAs, and ... The Claims Adjudication Associate is responsible for evaluating claims submitted by policyholders ...

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Manager Adjudication information

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$35.5K

$86.4K

$117K

How much do manager adjudication jobs pay per year?

As of Jul 16, 2026, the average yearly pay for manager adjudication in the United States is $86,379.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,000.00 and $116,500.00 per year, depending on experience, location, and employer.

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 Manager Adjudication roles and responsibilities?

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, and why are they important?

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.
More about Manager Adjudication jobs
What cities are hiring for Manager Adjudication jobs? Cities with the most Manager Adjudication job openings:
What are the most commonly searched types of Adjudication jobs? The most popular types of Adjudication jobs are:
What states have the most Manager Adjudication jobs? States with the most job openings for Manager Adjudication jobs include:
What job categories do people searching Manager Adjudication jobs look for? The top searched job categories for Manager Adjudication jobs are:
Manager Adjudication jobs near you
Infographic showing various Manager Adjudication job openings in the United States as of July 2026, with employment types broken down into 87% Full Time, and 13% Contract. Highlights an 100% In-person job distribution, with an average salary of $86,379 per year, or $41.5 per hour.
Supervisor - Pharmacy Adjudication

Supervisor - Pharmacy Adjudication

Onco360

Buffalo, NY • On-site

$63 - $74.25/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Onco360 Pharmacy has a need for qualified candidates to fill our role of Pharmacy Adjudication Supervisor. This is an excellent opportunity to join our company and help with our expanding Specialty Pharmacy program! This is a full-time position, Monday to Friday 9:30 am to 6:00 pm EST.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.
We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.
Salary range starting at $46k and up depending on experience
Sign-On Bonus: $5,000 for employees starting before July 31, 2026.
We offer a variety of benefits including:
  • Medical; Dental; Vision
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Quarterly Incentive Bonuses
  • Tuition Reimbursement
  • Company paid benefits – life insurance; and short and long-term disability
The Pharmacy Adjudication Supervisor is responsible for all aspects of pharmacy claims adjudication, accuracy of pharmacy claims, resolution of third-party rejections, coordination of benefits, and patient outreach regarding any delay in medication delivery due to insurance claim rejections. This role requires advanced program knowledge and will provide quality control by routinely examining cases completed by team members.
Adjudication Supervisor Essential Functions:
  • Supervises adjudication staff in a leadership role to maintain a positive working environment by creating synergy and teamwork to minimize employee relations issues and reduce turnover. Communicates effectively across pharmacy and/or corporate teams and with patients, and successfully resolves issues.
  • Assists Director of Pharmacy Operations in day-to-day pharmacy operations and in implementing new procedures to ensure that the accurate and timely dispensing of quality pharmacy services is consistently delivered to all patients using effective service leadership and customer skills.
  • Works with pharmacy management to recruit, select, hire, orientate, develop, and train new associates. On an ongoing basis, evaluates, coaches, and utilizes performance management practices to motivate and set expectations for PA staff. In collaboration with management, drafts and delivers effective corrective action plans and disciplinary action to technicians performing at substandard levels.
  • Manages and reports on daily activity of vertical team members, including monitoring of daily workflow and Pulse reporting.
  • Handles escalations for difficult claim rejection resolution cases/questions to ensure accurate and timely completion of adjudication.
  • 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.
  • Contacts insurance companies to follow up on prior authorization requests, including determining if any additional information is needed, or whether the claim is in review, approved, or denied. Document all prior authorization information in patient profile.
  • Works with Pharmacy Technician Manager and/or Director of Pharmacy Operations on other responsibilities, projects, implementations, and initiatives as needed.
  • Maintains 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.
Adjudication Supervisor Qualifications:
Education/Learning Experience
  • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Knowledge of insurance and applicable regulations
  • Desired: Associates or Bachelor’s Degree, Certified Pharmacy Technician, Specialty pharmacy experience
Work Experience
  • Required: 4+ years pharmacy or pharmacy adjudication or equivalent experience, previous leadership experience
  • Desired: 5+ years pharmacy or pharmacy adjudication or equivalent experience, 1+ years supervisor experience, Specialty pharmacy experience
Skills/Knowledge
  • Required: NDC medication billing, PBM and medical contracts, healthcare audit experience, knowledge of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, excellent interpersonal skills, able to work with all levels of management and staff, vast knowledge of pharmacy terminology and process including sig codes, and roman numerals, brand/generic names of medication, advanced typing, math and analytical skills.
  • Desired: Specialty pharmacy operations, leadership skills, independent decision-making abilities, able to conduct research, be resourceful, and self-reliant, excellent communication skills
Licenses/Certifications
  • Required: Registration with Board of Pharmacy as required by state law
  • Desired: Certified Pharmacy Technician (PTCB), Advanced Certified Pharmacy Technician with completion of Billing and Reimbursement certification
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, leadership

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