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Medical Adjudicator Jobs (NOW HIRING)

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 ...

ConnectiveRx

Analyst, Adjudication

Whippany, NJ · On-site +1

$48K - $69K/yr

Must also be willing to travel to adjudicator/s locations when necessary. Compensation & Benefits ... Employees at ConnectiveRx can access comprehensive benefits, including medical, dental, vision ...

ConnectiveRx

Analyst, Adjudication

Whippany, NJ · On-site

Must also be willing to travel to adjudicator/s locations when necessary. Compensation & Benefits ... Employees at ConnectiveRx can access comprehensive benefits, including medical, dental, vision ...

ConnectiveRx

Analyst, Adjudication

Whippany, NJ

Must also be willing to travel to adjudicator/s locations when necessary. Compensation & Benefits ... Employees at ConnectiveRx can access comprehensive benefits, including medical, dental, vision ...

CareMed Specialty Pharmacy

$23/hr

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 ...

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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 11, 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
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.
Claims Adjudicator II

Claims Adjudicator II

UNITE HERE HEALTH

Oak Brook, IL • On-site

$20.36 - $24.97/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

Job description

UNITE HERE HEALTH serves 200,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!


The Claims Adjudicator II position will receive, examine, verify and input submitted claim data, determine eligibility status, and review and adjudicate claims within established timeframes. This position utilizes multiple systems in order to perform the day-to-day functions of processing medical, disability, vision and dental claims, as well as, provider and member driven inquiries.

ESSENTIAL JOB FUNCTIONS AND DUTIES

  • Screens claims for completeness of necessary information
  • Verifies participant/dependent eligibility
  • Interprets the plan benefits from the Summary Plan Description (SPD)/Plan Documents
  • Codes basic information and selects codes to determine payment liability amount
  • Evaluates diagnoses, procedures, services, and other submitted data to determine the need for further investigation in relation to benefit requirements, accuracy of the claim filed, and the appropriateness or frequency of care rendered
  • Determines the need for additional information or documentation from participants, employers, providers and other insurance carriers
  • Handles the end to end process of Medicare Secondary Payer (MSP) files
  • Processes Personal Injury Protection (PIP) claims
  • Requests overpayment refunds, maintains corresponding files and performs follow-up actions
  • Handles verbal and written inquiries received from internal and external customers
  • Processes Short Term Disability claims
  • Adjudicates claims according to established productivity and quality goals
  • Achieve individual established goals in order to meet or exceed departmental metrics

ESSENTIAL QUALIFICATIONS

  • 3 ~ 5 years of direct experience minimum in a medical claim adjudication environment
  • Working knowledge and experience in interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits
  • Experience with eligibility verification, medical coding, coordination of benefits, and subrogation and it’s related processes
  • Experience with medical terminology, ICD10 and Current Procedural Technology (CPT) codes
  • Fluency (speak and write) in Spanish, preferred

Salary range for this position: Hourly $20.36 - $24.97. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) Fully Remote, after 1-week training onsite in Oak Brook, IL. (Travel and Lodging paid for by UHH)

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).

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