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Manager Adjudication Jobs (NOW HIRING)

Protection Strategies Inc

Adjudicator

Washington, DC · On-site

$90K - $100K/yr

Manage and prepare for government signature requests for additional information and Suitability ... OSSI will only provide the contractor training on OSSI adjudication processes. * Proficient in ...

Protection Strategies Inc

Adjudicator

Washington, DC · On-site

$90K - $100K/yr

Manage and prepare for government signature requests for additional information and Suitability ... OSSI will only provide the contractor training on OSSI adjudication processes. * Proficient in ...

Wayne Farms LLC

Background Adjudicator

Oakwood, GA · On-site

Risk Management: * Advise Talent Acquisition, HR, and Hiring Leaders on adjudication outcome or escalation to legal and risk posture. * Serve as point of contact for complex or sensitive cases.

Protection Strategies Inc

Adjudicator

Washington, DC · On-site

$90K - $100K/yr

Manage and prepare for government signature requests for additional information and Suitability ... OSSI will only provide the contractor training on OSSI adjudication processes. * Proficient in ...

Wayne Farms LLC

Background Adjudicator

Oakwood, GA · Hybrid

Risk Management: * Advise Talent Acquisition, HR, and Hiring Leaders on adjudication outcome or escalation to legal and risk posture. * Serve as point of contact for complex or sensitive cases.

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Manager Adjudication information

See salary details

$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.
Pharmacy Claims Adjudication Specialist

Pharmacy Claims Adjudication Specialist

Onco360

Waltham, MA

$26/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 17 days ago

Job description

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Waltham, MA. 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 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 $26.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before August 31, 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.
  • Documenst 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

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