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Medical Adjudicator Jobs (NOW HIRING)

Protection Strategies Inc

Adjudicator

Washington, DC · On-site

$90K - $100K/yr

Join Our Team as a HHS Adjudicator! Who We Are: At Protection Strategies, Inc. (PSI), a Service ... Medical, Dental, Vision, Telemedicine * Financial Support: 401(K) Retirement Plan, Tuition ...

Protection Strategies Inc

Adjudicator

Washington, DC · On-site

$90K - $100K/yr

Join Our Team as a HHS Adjudicator! Who We Are: At Protection Strategies, Inc. (PSI), a Service ... Medical, Dental, Vision, Telemedicine * Financial Support: 401(K) Retirement Plan, Tuition ...

Diverse Lynx

Claims Adjudicator

$19/hr

Claims Adjudication: Review, verify, and process medical claims from start to finish, ensuring compliance with company policies and benefit guidelines. * Documentation Analysis: Evaluate claim ...

NaphCare

Senior Claims Adjudicator

Birmingham, AL · On-site

Senior Claims Adjudicator Location US-AL-Birmingham ID 2026-30871 Category Accounting/Finance ... NaphCare is a family owned, medical technology company that has been delivering high quality health ...

Naphcare, Inc.

Senior Claims Adjudicator

Birmingham, AL · On-site

NaphCare is a family owned, medical technology company that has been delivering high quality health ... Responsibilities for Senior Claim Adjudicator: * Utilize claims processing experience and working ...

NaphCare

Senior Claims Adjudicator

Birmingham, AL · On-site

NaphCare is a family owned, medical technology company that has been delivering high quality health ... Responsibilities Responsibilities for Senior Claim Adjudicator: * Utilize claims processing ...

Naphcare, Inc.

Senior Claims Adjudicator

Birmingham, AL · On-site

NaphCare is a family owned, medical technology company that has been delivering high quality health ... Responsibilities for Senior Claim Adjudicator: * Utilize claims processing experience and working ...

State of Maine

Disability Claims Adjudicator

Winthrop, ME · On-site

$54K - $76K/yr

As a Disability Claims Adjudicator, you request and research prior medical records, collaborate with in-house Doctors and Psychologists around functional limitations, conduct vocational work analyses ...

NaphCare

Senior Claims Adjudicator

Birmingham, AL · On-site

NaphCare is a family owned, medical technology company that has been delivering high quality health ... Responsibilities Responsibilities for Senior Claim Adjudicator: * Utilize claims processing ...

State of Maine

Disability Claims Adjudicator

Winthrop, ME · On-site

$54K - $76K/yr

As a Disability Claims Adjudicator, you request and research prior medical records, collaborate with in-house Doctors and Psychologists around functional limitations, conduct vocational work analyses ...

NaphCare

Senior Claims Adjudicator

Vestavia Hills, AL · On-site

NaphCare is a family owned, medical technology company that has been delivering high quality health ... Responsibilities Responsibilities for Senior Claim Adjudicator: * Utilize claims processing ...

Maine

Disability Claims Adjudicator

Winthrop, ME · Hybrid

$54K - $76K/yr

As a Disability Claims Adjudicator, you request and research prior medical records, collaborate with in-house Doctors and Psychologists around functional limitations, conduct vocational work analyses ...

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Medical Adjudicator information

See salary details

$32K

$61.9K

$93K

How much do medical adjudicator jobs pay per year?

As of Jun 30, 2026, the average yearly pay for medical adjudicator in the United States is $61,924.00, according to ZipRecruiter salary data. Most workers in this role earn between $48,500.00 and $71,000.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Medical Adjudicator, and why are they important?

To thrive as a Medical Adjudicator, you need in-depth medical knowledge, analytical skills, and a relevant healthcare qualification such as an RN, MD, or related health sciences degree. Familiarity with case management software, electronic health records (EHRs), and government or insurance claims systems is typically required. Strong attention to detail, critical thinking, and effective written communication are vital soft skills for this role. These abilities are essential to accurately assess claims, ensure fair decisions, and uphold regulatory standards in medical adjudication processes.

What is medical adjudication?

Medical adjudication is the process used by medical adjudicators to review and evaluate insurance claims, medical bills, or healthcare services to determine their validity, coverage, and appropriate payment. It involves assessing medical documentation, coding, and compliance with policies, often requiring knowledge of medical terminology and insurance regulations. This process ensures accurate reimbursement and proper claim processing within healthcare and insurance settings.

What is the difference between Medical Adjudicator vs Medical Claims Processor?

AspectMedical AdjudicatorMedical Claims Processor
Required CredentialsMedical degree or relevant healthcare certification, knowledge of insurance policiesHigh school diploma or equivalent, basic understanding of claims processing
Work EnvironmentHealthcare offices, insurance companies, remote workClaims processing centers, insurance companies, remote options
Employer & Industry UsageInsurance companies, third-party administrators, healthcare providersInsurance companies, third-party administrators, healthcare payers
Common Search & Comparison IntentUnderstanding roles, qualifications, and responsibilitiesComparing entry-level claims processing tasks and requirements

While both roles involve working within the insurance and healthcare industries, Medical Adjudicators typically have more advanced healthcare credentials and focus on reviewing complex claims and medical necessity. Medical Claims Processors handle the initial processing of claims, often with less specialized healthcare knowledge. The choice depends on your experience level and career goals within the insurance and healthcare sectors.

What is the most needed job in the medical field right now?

Medical adjudicators are in high demand as healthcare organizations seek professionals to review insurance claims, ensure compliance, and determine coverage eligibility. Strong analytical skills, attention to detail, and knowledge of medical terminology are essential for success in this role, which often requires certification and familiarity with medical records systems.

What are the main responsibilities of an adjudicator?

A medical adjudicator reviews insurance claims and medical documentation to determine the validity of benefits or coverage. They assess medical records, ensure compliance with policies, and make decisions based on clinical guidelines, often using specialized software and requiring knowledge of healthcare regulations.

What are medical adjudicators?

Medical adjudicators are professionals who review medical evidence and make decisions about disability claims, insurance benefits, or other healthcare-related cases. They assess whether an individual meets specific medical criteria for benefits or coverage, often working for government agencies, insurance companies, or healthcare organizations. Their role involves analyzing medical records, consulting with healthcare providers, and ensuring decisions comply with relevant guidelines and laws.

How does a Medical Adjudicator typically collaborate with other professionals in the disability claims process?

Medical Adjudicators frequently work closely with case managers, physicians, and specialists to review and assess medical evidence for disability claims. Collaboration involves discussing complex cases, clarifying medical information, and sometimes participating in interdisciplinary meetings to ensure fair and accurate decisions. Effective communication and teamwork are essential, as Medical Adjudicators must balance medical guidelines with policy requirements while ensuring all perspectives are considered in the adjudication process.

What medical trade pays the most?

Medical adjudicators typically earn competitive salaries, but specialized roles such as medical directors, healthcare executives, or physicians involved in insurance and claims processing tend to have the highest pay. Advanced certifications, experience, and management responsibilities often lead to higher compensation in these fields.
More about Medical Adjudicator jobs
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Medical Adjudicator jobs near you
Adjudicator

Adjudicator

Protection Strategies Inc

Washington, DC • On-site

$90K - $100K/yr

Full-time

Medical, Dental, Vision, Retirement

Posted 24 days ago

Job description

Join Our Team as a HHS Adjudicator!


Who We Are:

At Protection Strategies, Inc. (PSI), a Service-Disabled Veteran Owned Small Business, we engage with industry professionals to provide top-tier security solutions and personnel security expertise for the U.S. Government. Our mission is to safeguard our clients' interests with integrity and innovation, reshaping the landscape of security.


Why PSI?:

Become part of a dedicated team that values people first and believes in making a meaningful impact. We offer cutting-edge solutions that promote safety and protect critical infrastructure. Your hard work will be recognized in our mission-driven culture.


Apply now** to join PSI and help shape a safer future!


What We Offer:

  • Comprehensive Benefits: Medical, Dental, Vision, Telemedicine
  • Financial Support: 401(K) Retirement Plan, Tuition Assistance, Disability Products
  • Wellness Programs: Employee Assistance, GoodRx, Commuter Benefits
  • Flexible Spending Accounts: HSA + HRA


Position Overview:

Reviews and evaluates background investigations to assess an individual’s character, conduct, and overall suitability for employment, as well as eligibility for access to classified information. Applies established guidelines and sound judgment to make fair and consistent determinations based on investigative findings.


Key Responsibilities:

  • Screen, review, and evaluate completed "issue" and "non-issue" OPM conducted Background Investigation
  • Identify and analyze derogatory and mitigating information for suitability (5CFR 731 E.O. 10450) and for national security (E.O. 12968)
  • Request support documentation from applicant related to financial, criminal, or other matters, as required
  • Prepare detailed adjudicative analytical summaries recommending further courses of action for processing with supporting rationale
  • Manage and prepare for government signature requests for additional information and Suitability Letters and Letters of Advisement (LOA's).
  • Manage caseload with appropriate follow-up based on government timelines
  • Review appeals and reconsideration requests and prepare a summary of recommended Findings


Qualifications:

  • Ability to work independently and with minimal supervision
  • Bachelor's Degree or an equivalent combination of education and related experience in personnel security.
  • Five (5) years of experience adjudicating suitability and security background investigations.
  • Successful completion of an accredited Basic and Advanced Suitability Adjudication Course. The DOD course is sufficient for the online Basic Adjudicator training; however, the Advance Suitability Adjudication Course is the responsibility of the contractor. OSSI will only provide the contractor training on OSSI adjudication processes.
  • Proficient in Microsoft applications and knowledge of processing e-QIP.
  • Competencies:
    • Ability to multi-task
    • Proficient written and verbal communication skills
    • Work with tight and often conflicting deadlines
    • Coordination of work activities with other persons and groups
    • Computer skills (Microsoft Office Suite) and other programs and systems to facilitate work completion
    • Interact with representatives, executives, and directors
    • Strong report writing skills
    • Considerable knowledge of the laws, rules and regulations governing Personnel Security and Suitability.
    • Considerable skill in expressing ideas, conclusions, and make recommendations effectively, clearly and concisely, both orally and in writing.


EEO Statement:

We are an equal opportunity employer. All qualified applicants will be considered without discrimination based on race, color, religion, sex, national origin, age, disability, or protected veteran status. Employment offers will be contingent on passing a pre-employment drug screen.


Ready to Make a Difference?

Apply now to join PSI and help shape a safer future!