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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 ...

NaphCare

Senior Claims Adjudicator

Birmingham, AL

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

AmeriPharma

Claims Adjudicator

Laguna Hills, CA · On-site

Full benefits package including medical, dental, vision, and life * Great pay and general ... Casual Fridays Job Summary The Claims Adjudicator is responsible for overseeing the claims ...

WellSense Health Plan

Claims Adjudicator

$18.27 - $25.72/hr

... adjudication. · Alerts claims management to claims aging issues as well as provider billing ... Competencies, Skills, and Attributes: · Working knowledge of medical terminology as well as CPT4 ...

AmeriPharma

Claims Adjudicator

Laguna Hills, CA

Full benefits package including medical, dental, vision, and life * Great pay and general ... Casual Fridays Job Summary The Claims Adjudicator is responsible for overseeing the claims ...

UNITE HERE HEALTH

Claims Adjudicator III

Oak Brook, IL · On-site

$23.79 - $29.13/hr

This involves adjudicating complex medical, vision, dental, and short-term disability claims, as well as, escalated member and provider inquiries within established timeframes. The Claims Adjudicator ...

AmeriPharma

Claims Adjudicator

Laguna Hills, CA · On-site

$29 - $32/hr

Full benefits package including medical, dental, vision, and life * Great pay and general ... Casual Fridays Job Summary The Claims Adjudicator is responsible for overseeing the claims ...

UNITE HERE HEALTH

Claims Adjudicator II

Oak Brook, IL · On-site

$20.36 - $24.97/hr

The Claims Adjudicator II position will receive, examine, verify and input submitted claim data ... Experience with medical terminology, ICD10 and Current Procedural Technology (CPT) codes * Fluency ...

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Medical Adjudicator information

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$32K

$61.9K

$93K

How much do medical adjudicator jobs pay per year?

As of Jun 9, 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 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 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.
More about Medical Adjudicator jobs
What cities are hiring for Medical Adjudicator jobs? Cities with the most Medical Adjudicator job openings:
What states have the most Medical Adjudicator jobs? States with the most job openings for Medical Adjudicator jobs include:
What job categories do people searching Medical Adjudicator jobs look for? The top searched job categories for Medical Adjudicator jobs are:
Medical Adjudicator jobs near you
Infographic showing various Medical Adjudicator job openings in the United States as of June 2026, with employment types broken down into 2% As Needed, 81% Full Time, and 17% Part Time. Highlights an 81% Physical, 2% Hybrid, and 17% Remote job distribution, with an average salary of $61,924 per year, or $29.8 per hour.
Adjudicator

Adjudicator

Protection Strategies Inc

Washington, DC • On-site

$90K - $100K/yr

Full-time

Medical, Dental, Vision, Retirement

This job post has expired today. Applications are no longer accepted.

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!