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Medical Adjudicator Jobs (NOW HIRING)

Disability Claims Adjudicator

Winthrop, ME ยท 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 ...

Claims Adjudicator II

Oak Brook, IL ยท On-site

$20.36 - $24.97/hr

The Claims Adjudicator II position will receive, examine, verify and input submitted medical claim data, determine eligibility status, and review and adjudicate claims within established timeframes.

Claims Adjudication Associate

Charlotte, NC ยท Hybrid

$17.25 - $23.50/hr

In year one, this individual will train on the JUDI Medical adjudication system. This individual will be responsible for maintaining the operational adjudication process, member, and provider ...

Claims Adjudication Associate

Charlotte, NC ยท On-site

$82K - $103K/yr

In year one, this individual will train on the JUDI Medical adjudication system. This individual will be responsible for maintaining the operational adjudication process, member, and provider ...

Claims Adjudication Associate

Charlotte, NC ยท On-site

$82K - $103K/yr

In year one, this individual will train on the JUDI Medical adjudication system. This individual will be responsible for maintaining the operational adjudication process, member, and provider ...

Claims Adjudication Associate

Charlotte, NC ยท On-site

$82K - $103K/yr

In year one, this individual will train on the JUDI Medical adjudication system. This individual will be responsible for maintaining the operational adjudication process, member, and provider ...

Claims Adjudication Associate

Charlotte, NC ยท On-site

$82K - $103K/yr

In year one, this individual will train on the JUDI Medical adjudication system. This individual will be responsible for maintaining the operational adjudication process, member, and provider ...

Intermediate Claims Adjudicator And Administrator Manulife Insurance business unit is a leading ... Review claims and underwriting files for proper disclosure of past medical history, exclusions ...

Adjudication Project Manager - United States (Remote) ICON is a global healthcare intelligence and ... Health and wellbeing programmes including medical, dental, and vision coverage where applicable

Adjudication Project Manager - United States (Remote) ICON is a global healthcare intelligence and ... Health and wellbeing programmes including medical, dental, and vision coverage where applicable

You'll review medical case files, track them through adjudication, and keep reserve units informed at every step. What You'll Do * Update case status in AIMWTS, ECT, PEPP, and other systems of record ...

You'll review medical case files, track them through adjudication, and keep reserve units informed at every step. What You'll Do * Update case status in AIMWTS, ECT, PEPP, and other systems of record ...

Showing results 21-40

Medical Adjudicator information

See salary details

$32K

$61.9K

$93K

How much do medical adjudicator jobs pay per year?

As of Sep 2, 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 is a medical adjudicator?

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 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.

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:

Infographic showing various Medical Adjudicator job openings in the United States as of August 2026, with employment types broken down into 88% Full Time, 7% Part Time, and 5% Contract. Highlights an 89% In-person, 4% Hybrid, and 7% Remote job distribution, with an average salary of $61,924 per year, or $29.8 per hour.

Disability Claims Adjudicator

Maine

Winthrop, ME โ€ข Hybrid

$54K - $76K/yr

Full-time

Medical, Dental, Retirement, PTO

Posted 12 days ago


Job description

If you are a current State of Maine employee, please submit your application through the internal application process using the Find Jobs report in PRISM. Seasonal employees who do not have PRISM access should apply through the State's career page and indicate on the application that they have previously worked for the State.

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Department ofHealth and Human Services (DHHS)

Opening Date:August 20, 2026

Closing Date:September 2, 2026

Job Class Code:3065

Grade:25 (Professional & Technical)

Salary:$54,412.80 to $76,315.20 per year

Position Numbers:02024-1211

Location:Winthrop

This position allows for partial telework with management approval.

Currently, this position is not eligible for visa sponsorship or STEM OPT extensions.

Are you interested in a career in Public Service and assisting some of Maine's most vulnerable? Do you enjoy complex, fast-paced work with a high degree of independence? Do you want to be part of a growing team and positive work culture?

Maine Disability Determination Services is hiring! DDS provides disability decisions for Social Security Disability Benefits. 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, and ultimately make disability determinations for the Social Security Administration. Good candidates will have a dedication to public service, the ability to learn quickly and manage different and complex tasks efficiently and display a collaborative approach with excellent and compassionate customer service. In-depth training will be provided and a remote option for up to 3 days a week is available after the first 8-12 months. On-going staff development available as well as the ability to collaborate with many state, local, and federal partners. For more information watch the linked video. (Please note that this video uses the term 'claims examiner' which is the same position in Maine as 'Claims Adjudicator').

Core Responsibilities:

This is administrative work involving the review and analysis of initial, reconsideration, and continuing disability review claims for disability benefits under the Social Security Act. Duties include:

Determine eligibility for disability benefits according to federal regulations, and complete written disability determinations in order to provide assistance.

Contact claimants, treating providers, and other approved contacts as needed in order to obtain medical and vocational evidence.

Determine eligibility for advanced payments for claimants with severe disabilities in order to provide immediate aid to those eligible.

Recognize and initiate steps to resolve discrepancies found within the various disability application forms. Involve the appropriate Social Security office as needed to resolve issues.

Collect, review, examine, summarize, and analyze medical and psychiatric records.

Review case-specific vocational information and complete vocational assessment per Social Security policy.

Authorize and arrange for medical and psychiatric consultative examinations in order to comply with program requirements.

Write detailed letters to claimants, medical consultants, and state and federal agencies in order to request information and inform claimants of the reasons and results of disability decisions.

Assign codes to written decisions in order to develop and maintain statistical data.

Perform additional special duties as assigned, such as quality assurance, mentoring, training, professional relations activities, processing Canadian claims, and other special projects in order to meet division needs.

Preference given to candidates with any of the following:

Familiarity with SSA disability policies and procedures

Successful experience in managing large individual caseloads

Ability to work in a production environment with quality and processing speed goals.

Sensitivity to the needs of the public and customer focus.

Ability to communicate effectively and work cooperatively through phone, email, video-conferencing, and other communication technologies.

Has demonstrated skills of time management, attention to details, problem solving and analysis

Ability to learn complex medical information, vocational policies, and ongoing technologies.

Minimum Qualifications:

Intermediate education, training, and/or experience in a field involving research, investigation, data analysis, and/or development of comprehensive reports.

Candidates are required to have identification that is "REAL ID" compliant.

Your conditional job offer, and access to the Social Security Administration's (SSA's) system, data, information, and/or premises are contingent upon you passing the SSA suitability process.

*Note: This covers the preliminary screening (pre-screen) and the final background adjudication stage of the suitability process.

Thinking about applying?

Research shows that people from historically excluded communities tend to apply to jobs only when they check every box in the posting. If you're currently reading this and hesitating to apply for that reason, we encourage you to go for it! Let us know how your experience and passion set you apart.

Agency information:

The Department of Health and Human Services (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people. The Department provides health and social services to approximately a third of the State's population, including children, families, older Mainers, and individuals with disabilities, mental illness, and substance use disorders. The Department also promotes public health, operates two state psychiatric hospitals, and provides oversight to health care providers.

Within the Office for Family Independence (OFI) is the Division of Disability Determination Services (DDS). DDS is responsible for evaluating and making medical decisions on claims for Social Security disability benefits. DDS has vacancies in Winthrop.

Application Information:

For additional information about this position please contact Mora Camenga at Mora.Camenga@ssa.govor Samantha Gilman at Samantha.Gilman@ssa.gov

Please submit all documents or files in PDF format.

To request a paper application, please contact Mandy.Hernandez@Maine.gov

Benefits of working for the State of Maine:

No matter where you work across Maine state government, you find employees who embody our state motto-"Dirigo" or "I lead"-as they provide essential services to Mainers every day. We believe in supporting our workforce's health and wellbeing with a valuable total compensation package, including:

  • Work-Life Fit- Rest is essential. Take time for yourself using 13 paid holidays and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave. When you or immediate members of your family are ill, utilize 12 days of sick leave per year.
  • Health Insurance Coverage- The State of Maine pays85%-95% of employee-only premiums ($12,213.60 - $13,650.48 annual value), depending on salary. Use this chart to find thepremium costsfor you and your family, including the percentage of dependent coverage paid by the State.
  • Health Insurance Premium Credit- Participation decreases employee-only premiums by 5%. Visit the Office of Employee Health and Wellness for more information aboutprogram requirements.
  • Dental Insurance- The State of Maine pays 100% of employee-only dental premiums ($365.28 annual value).
  • Retirement Plan- The State contributes the equivalent of 14.06% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS), on behalf of the employee.
  • Gym Membership Reimbursement - Improve overall health with regular exercise and receive up to $40 per month to offset this expense.
  • Health and Dependent Care Flexible Spending Accounts - Set aside money pre-tax to help pay for out-of-pocket health care expenses and/or daycare expenses.
  • Public Service Student Loan Forgiveness - The State of Maine is a qualified employer for this federal program. For more information, visit the Federal Student Aid office.
  • Living Resources Program - Navigate challenging work and life situations with our employee assistance program.
  • Parental leaveis one of the most important benefits for any working parent. All employees who are welcoming a child-including non-birthing and adoptive parents-receivesix weeks of fully paid parental leave. Additional, unpaid leave may also be available, under theFamily and Medical Leave Act.
  • Voluntary Deferred Compensation - Save additional pre-tax funds for retirement in a MaineSaves 457(b) account through payroll deductions.

State employees are eligible for anextensive and highly competitive benefits package, covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness.

Note: Benefits may vary somewhat according to specific collective bargaining agreements and are prorated foranything less than full-time.

There's a job and then there's purposeful, transformative work. Our aim is to create a workplace where you can learn, grow, and continuously refine your skills. Applicants demonstrate job requirements in differing ways, and we appreciate that many skills and backgrounds can make people successful in this role.

As an Equal Opportunity employer, Maine State Government embraces a culture of respect and awareness. We are committed to creating a strong sense of belonging for all team members, and our process ensures an inclusive environment to applicants of all backgrounds including diverse race, color, sex, sexual orientation or gender identity, physical or mental disability, religion, age, ancestry, national origin, familial status or genetics.

If you're looking for a great next step, and want to feel good about what you do, we'd love to hear from you. Please note reasonable accommodations are provided to qualified individuals with disabilities upon request.

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If you are unable to complete the online application, please contact the Human Resources representative listed on the job opening you are interested in applying for. They will work with you for an alternative method of submitting.