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Medical Claims Adjudicator Jobs (NOW HIRING)

Independent Health

Claims Adjudicator

Buffalo, NY · On-site

$18/hr

Six (6) months of medical claims processing/medical billing experience, customer service experience ... claims adjudication. * Analyze, identify and research, as needed, edits which demonstrate ...

Judi Health

Claims Adjudication Associate

Charlotte, NC · Hybrid

$17.25 - $23.50/hr

In year one, this individual will train on the JUDI Medical adjudication system. This individual ... The Claims Adjudicator reviews the facts of each case and applies the applicable laws, regulations ...

Capital Rx

Claims Adjudication Associate

Charlotte, NC · On-site

$82K - $103K/yr

In year one, this individual will train on the JUDI Medical adjudication system. This individual ... The Claims Adjudicator reviews the facts of each case and applies the applicable laws, regulations ...

Judi Health

Claims Adjudication Associate

Charlotte, NC · On-site

$82K - $103K/yr

In year one, this individual will train on the JUDI Medical adjudication system. This individual ... The Claims Adjudicator reviews the facts of each case and applies the applicable laws, regulations ...

Judi Health

Claims Adjudication Associate

Charlotte, NC · On-site

$82K - $103K/yr

In year one, this individual will train on the JUDI Medical adjudication system. This individual ... The Claims Adjudicator reviews the facts of each case and applies the applicable laws, regulations ...

Capital Rx

Claims Adjudication Associate

Charlotte, NC · On-site

$82K - $103K/yr

In year one, this individual will train on the JUDI Medical adjudication system. This individual ... The Claims Adjudicator reviews the facts of each case and applies the applicable laws, regulations ...

Naphcare, Inc.

Senior Claims Adjudicator

Birmingham, AL · On-site

Overview NaphCare is hiring an experienced Senior Claims Adjudicator just like you to join our team ... NaphCare is a family owned, medical technology company that has been delivering high quality health ...

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 ...

Naphcare, Inc.

Senior Claims Adjudicator

Birmingham, AL · On-site

Overview NaphCare is hiring an experienced Senior Claims Adjudicator just like you to join our team ... NaphCare is a family owned, medical technology company that has been delivering high quality health ...

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 medical claim data, determine eligibility status, and review and adjudicate claims within established timeframes.

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

Overview NaphCare is hiring an experienced Senior Claims Adjudicator just like you to join our team ... NaphCare is a family owned, medical technology company that has been delivering high quality health ...

NaphCare

Senior Claims Adjudicator

Vestavia Hills, AL · On-site

Overview NaphCare is hiring an experienced Senior Claims Adjudicator just like you to join our team ... NaphCare is a family owned, medical technology company that has been delivering high quality health ...

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Medical Claims Adjudicator information

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$15

$26

$34

How much do medical claims adjudicator jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for medical claims adjudicator in the United States is $26.74, according to ZipRecruiter salary data. Most workers in this role earn between $22.60 and $30.29 per hour, depending on experience, location, and employer.

What is a medical claims adjudicator?

Medical Claims Adjudicators are professionals who review and process health insurance claims to determine if they are valid and eligible for payment. They analyze medical records, insurance policies, and billing codes to ensure claims comply with regulations and company guidelines. Their role is essential in preventing fraud and ensuring that healthcare providers and patients are reimbursed accurately and promptly.

What are the key skills and qualifications needed to thrive as a medical claims adjudicator?

To thrive as a Medical Claims Adjudicator, you need a strong understanding of medical terminology, health insurance policies, and claims processing, often supported by experience in healthcare administration or a related certification. Familiarity with claims management software, electronic health records (EHR) systems, and coding systems like ICD-10 and CPT is typically required. Attention to detail, analytical thinking, and effective communication are standout soft skills for this role. These skills ensure accurate and timely claims processing, minimize errors, and help maintain compliance with regulations, ultimately supporting both providers and patients.

What are some common challenges faced by medical claims adjudicators, and how can they be managed?

Medical Claims Adjudicators often encounter challenges such as interpreting complex medical documentation, ensuring compliance with ever-changing insurance policies, and managing a high volume of claims under tight deadlines. To manage these challenges, it is important to stay updated on policy guidelines, utilize available training resources, and communicate effectively with healthcare providers and team members. Strong organizational skills and attention to detail are essential for minimizing errors and ensuring claims are processed accurately and efficiently.

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

AspectMedical Claims AdjudicatorMedical Claims Processor
CredentialsTypically requires a high school diploma or equivalent; certifications like CPC or CPC-A are commonUsually requires a high school diploma; certifications are less common
Work EnvironmentInsurance companies, healthcare providers, or third-party administratorsInsurance companies, healthcare providers, or billing offices
Job FocusReviewing, evaluating, and making decisions on claims based on policies and regulationsEntering and processing claim data for payment
Common Search IntentUnderstanding roles, responsibilities, and differencesProcessing claims efficiently and accurately

While both roles involve handling healthcare claims, Medical Claims Adjudicators focus on reviewing and making decisions on claims, ensuring compliance with policies. Medical Claims Processors primarily input and process claim data for payment. The adjudicator role often requires more analytical skills and decision-making authority, whereas processors focus on data entry and accuracy.

Is claims processing a stressful job?

Medical Claims Adjudicators often find claims processing to be a demanding task due to the need for accuracy, attention to detail, and adherence to strict guidelines. The job can involve repetitive work and tight deadlines, which may contribute to stress, but it also offers structured workflows and training to manage workload effectively.
More about Medical Claims Adjudicator jobs

What states have the most Medical Claims Adjudicator jobs?

States with the most job openings for Medical Claims Adjudicator jobs include:

What job categories do people searching Medical Claims Adjudicator jobs look for?

The top searched job categories for Medical Claims Adjudicator jobs are:

Medical Claims Adjudicator jobs near you
Infographic showing various Medical Claims Adjudicator job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 14% Part Time, and 6% Contract. Highlights an 87% Physical, 1% Hybrid, and 12% Remote job distribution, with an average salary of $55,623 per year, or $26.7 per hour.

Claims Adjudicator

Buffalo, NY • On-site

Independent Health

8.1

Company rating: 8.1 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

159th of 315 rated insurance

Great coworkers

People enjoy working here

Good employer

Learn more about Independent Healthexternal

$18/hr

Other

PTO

Re-posted 20 days ago

Job description

FIND YOUR FUTURE
We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
Overview
The Claims Adjudicator is responsible for adjudicating and adjusting medical and/or dental claims against established criteria, and in accordance with specific clients SPD's maintaining goals in accuracy and productivity. The Claims Adjudicator is responsible to respond to client, member, and/or provider inquiries on claim status, benefit designs, and claim payments working in conjunction with the Customer Service Representative.
Qualifications
  • High school diploma required; medical office assistant certificate and/or college degree preferred.
  • Six (6) months of medical claims processing/medical billing experience, customer service experience preferably in a healthcare related or social services setting; OR combination of experience.
  • Knowledge of medical billing procedures; CPT and ICD-9 coding and medical terminology knowledge required.
  • Proficiency with data entry skills and Microsoft Office products.
  • Solid organizational skills with attention to detail and follow through.
  • Good written, verbal and interpersonal communication skills. Demonstrated ability to effectively communicate with internal and external customers.
  • Must be able to work collaboratively. Flexibility to work additional hours as needed.
  • Proven examples of displaying Nova's Core 4: Act with Passion, Work Together, Be Accountable, Build Trust.
Essential Accountabilities
  • Adjudicate claims based on established policies and procedures for facility, professional, member submitted, pharmacy and dental claim edits. This is inclusive for both in and out-of-network benefits.
  • Review vouchers/explanation of payments to identify and resolve claims related issues.
  • Continually meet department performance measures as it relates to production, accuracy, knowledge of policy and procedure and timeliness of claims adjudication.
  • Analyze, identify and research, as needed, edits which demonstrate inconsistency in regard to policy, payment issues and coding issues.
  • Maintain current contract, summary plan description and benefit knowledge.
  • Ability to adhere to departmental deadlines and turn-around times, to be compliant with State and Federal regulations.
  • Effectively utilize critical thinking skills to process claims.
  • Efficiently navigate through systems and applications to locate information specific to claim scenarios.
  • Accurately locate resources and read, interpret, and apply appropriate information to various claim scenarios.
  • Identify and communicate process opportunities or improvements.
  • Prioritize and manage claim processing workload in an efficient manner.
  • Effective written, verbal and interpersonal communication with other departments within Independent Health to resolve problems related to claims payment.

Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range: $18.00 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant's race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub.

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