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Medical Adjudicator Jobs (NOW HIRING)

Onco360

Supervisor - Pharmacy Adjudication

Louisville, KY · On-site

$59.50 - $70/hr

Medical; Dental; Vision * 401k with a match * Paid Time Off and Paid Holidays * Quarterly Incentive ... Adjudication Supervisor Essential Functions: * Supervises adjudication staff in a leadership role ...

Onco360

Supervisor - Pharmacy Adjudication

Woodridge, IL · On-site

$64.50 - $75.75/hr

Medical; Dental; Vision * 401k with a match * Paid Time Off and Paid Holidays * Quarterly Incentive ... Adjudication Supervisor Essential Functions: * Supervises adjudication staff in a leadership role ...

Onco360

Supervisor - Pharmacy Adjudication

Indianapolis, IN · On-site

$62.25 - $73/hr

Medical; Dental; Vision * 401k with a match * Paid Time Off and Paid Holidays * Quarterly Incentive ... Adjudication Supervisor Essential Functions: * Supervises adjudication staff in a leadership role ...

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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 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:

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 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.

Pharmacy Claims Adjudication Specialist

Onco360

Salt Lake City, UT • Remote

$23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 4 days ago

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

20th of 113 rated pharmacies

Job description

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy working in Mountain Time Zone. This will be a Full-Time position. This is a remote/hybrid opportunity,
Shift times start at 10am Mountain Time Zone until 8pm Mountain Time Zone.
Full-Time position may work remotely but MUST HAVE ACTIVE UTAH PHARMACY TECHNICIAN credentials from the State Board of Pharmacy.
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 $23.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before September 30th, 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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