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Medical Claims Adjudicator Jobs (NOW HIRING)

NaphCare

Senior Claims Adjudicator

Birmingham, AL · On-site

Senior Claims Adjudicator Location US-AL-Birmingham ID 2026-30871 Category Accounting/Finance ... NaphCare is a family owned, medical technology company that has been delivering high quality health ...

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 ...

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 ...

NaphCare

Senior Claims Adjudicator

Birmingham, AL

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 ...

Judi Health

Claims Adjudication Associate

New York, NY · On-site +1

$19.50 - $26.25/hr

The Claims Adjudication Associate is responsible for evaluating claims submitted by policyholders ... Evaluate complex medical claims, coverage issues, and benefit determinations by reviewing claim ...

Judi Health

Claims Adjudication Associate

Manhattan, NY · On-site

Claims Adjudication Associate Capital Rx is seeking a self-driven Claims Adjudication associate to ... Evaluate complex medical claims, coverage issues, and benefit determinations by reviewing claim ...

Capital Rx

Claims Adjudication Associate

Manhattan, NY · On-site

$19.50 - $26.50/hr

The Claims Adjudication Associate is responsible for evaluating claims submitted by policyholders ... Evaluate complex medical claims, coverage issues, and benefit determinations by reviewing claim ...

NTT Data Americas, Inc.

Medical Claims Processor

$17 - $18/hr

... adjudicated as per clients defined workflows, guidelines • Sustaining and meeting the client ... s) of Medical Claims experience * 2+ year(s) using a computer with Windows applications that ...

Adecco

Medical Claims Examiner

San Antonio, TX

$22.50/hr

Key Requirements Recent medical claims experience REQUIRED Experience with medical claims adjudication Knowledge of Medicaid and Medicare guidelines Strong understanding of healthcare terminology and ...

CornerStone Staffing

Medical Claims Analyst

Dallas, TX · On-site

$19/hr

Medical Claims Analyst Location Dallas, TX 75243 | Onsite Compensation & Schedule * $19.00/hour ... Respond to analyst inquiries and complete real-time follow-ups to support claims adjudication ...

New

Adecco

Medical Claims Examiner

San Antonio, TX

$22.50/hr

Hands-on experience with medical claims adjudication * Working knowledge of Medicaid and Medicare regulations * Strong understanding of healthcare terminology and claims workflows * Proven ability to ...

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Medical Claims Adjudicator information

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$34

How much do medical claims adjudicator jobs pay per hour?

As of Aug 8, 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 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.

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.
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, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $55,623 per year, or $26.7 per hour.

Claims Adjudicator

National Healthcare Solutions Group, Inc.

Miami, FL • On-site

Other

Medical

Re-posted 22 days ago

Job description

Claims Adjudicator

The Claims Adjudicator is responsible for reviewing, analyzing, and processing health insurance claims in accordance with established guidelines, contractual benefits and terms, and regulatory requirements. The claims adjudicator ensures that all claims are handled accurately, efficiently, and within specified timeframes, contributing to the overall effectiveness of the claims processing team. This role requires a detailed-oriented professional with a strong ability to follow instructions and a proactive approach to identifying and resolving discrepancies.

Essential Functions
  • Ensure all claims are processed in strict accordance with established guidelines and instructions.
  • Review and adjudicate claims in accordance with policy benefits.
  • Send claims for coverage analysis to the medical department in specific cases.
  • Regularly generate and analyze claims processing reports to identify discrepancies and ensure data accuracy.
  • Properly code procedures and diagnostics (CPT and ICD 10 coding)
  • Verify banking information.
  • Validate prescription medicines to the corresponding patient diagnosis.
  • Verify expenses with the renewal date for coverage.
  • Calculate expenses and deductible per policy year.
  • Verify waiting periods.
  • Verify pre-existing conditions and exclusions; deductible increases
  • Verify dates of service.
  • Verify currency conversions.
  • Verify general benefits of the policy according to the contracted plan.
Minimum Qualifications
  • Minimum 2 years' experience.
  • Bilingual (Spanish or Portuguese).
  • Experience in quality customer service.
  • General knowledge and proper management of Microsoft Office
  • Proactively identify discrepancies in claims; monitor claims patterns to identify opportunities for improvement.
  • Ability to work under pressure.
  • Ability to manage interpersonal relationships.
  • Effective oral and written communication skills.
  • Strong ability to follow detailed procedures and instructions with precision to ensure accurate and compliant claims adjudication.
Working Conditions

The following job-related working conditions are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.

Work Environment

The role primarily operates in an in-door, climate-controlled office setting working in close proximity to others. Noise level in the work environment is low to moderate. Light level provides adequate brightness for reading, computer work, and other tasks without causing glare or strain.

Physical Demands

The job primarily involves sedentary work with prolonged periods sitting at a desk. While performing the duties of this job, employees may occasionally be expected to:

  • exert up to 10 pounds of force and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
  • operate standard office equipment such as copiers, computers, telephones, printers, etc.
Travel Requirements

Minimal to no travel required

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