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Remote Adjudication Jobs (NOW HIRING)

Diverse Lynx

Claims Adjudicator

$19/hr

Tampa, FL (Remote after 8 Week Onsite Training) Duration: Full Time Salary: $19/Hr. + Benefits Job Overview:- Key Responsibilities * Claims Adjudication: Review, verify, and process medical claims ...

ImageNetLLC

Claims Examiner - Remote

Tampa, FL · Remote

Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid trainingto set you up for success * Comprehensive ...

Imagenet

Claims Examiner - Remote

Tampa, FL · Remote

Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid trainingto set you up for success * Comprehensive ...

Imagenet

Claims Examiner - Remote

Tampa, FL · On-site +1

Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid training to set you up for success * Comprehensive ...

Imagenet

Claims Quality Auditor - Remote

Tampa, FL · On-site +1

Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS, DMHC, CMS dispute handling regulations. What We Offer * Remote work offered * Equipment provided

ImageNetLLC

Claims Quality Auditor - Remote

Tampa, FL · Remote

Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS, DMHC, CMS dispute handling regulations. What We Offer * Remote work offered * Equipment provided

Imagenet

Claims Quality Auditor - Remote

Tampa, FL · Remote

Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS, DMHC, CMS dispute handling regulations. What We Offer * Remote work offered * Equipment provided

Integrated Management Strategies LLC

Remote Medical Coder

$19.25 - $24.25/hr

The role is fully remote within the US. We are proud of our national presence, and excited to offer ... adjudication. * Complete training on all government systems, including all annual and short notice ...

TEEMA

Hearing Officer - Remote

Phoenix, AZ · Remote

$34 - $36/hr

Hearing Officer (Legal Administration) Location: 100% Remote (Open to out-of-state candidates ... Adjudication: Conduct formal hearings via telephone or in person; make evidentiary rulings, control ...

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Remote Adjudication information

What is the difference between Remote Adjudication vs Remote Claims Processor?

AspectRemote AdjudicationRemote Claims Processor
CredentialsTypically requires healthcare or insurance industry certificationsRequires insurance or claims processing knowledge, often with certification
Work EnvironmentPrimarily analyzing and making decisions on claims remotelyProcessing and reviewing insurance claims remotely
Industry UsageCommon in healthcare, insurance, and government sectorsCommon in insurance companies and third-party administrators
Search/Comparison IntentUnderstanding roles involving claim decision-making remotelyUnderstanding roles focused on processing insurance claims remotely

Remote Adjudication involves analyzing and making decisions on claims, often requiring specialized certifications. Remote Claims Processors handle the review and processing of claims, focusing on data entry and verification. While both roles work remotely within the insurance or healthcare industry, adjudicators focus on decision-making, whereas claims processors handle the administrative processing of claims.

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What are the most commonly searched types of Adjudication jobs? The most popular types of Adjudication jobs are:
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Remote Adjudication jobs near you
Infographic showing various Remote Adjudication job openings in the United States as of July 2026, with employment types broken down into 4% Locum Tenens, 83% Full Time, 11% Part Time, 1% Temporary, and 1% Contract. Highlights an 77% Physical, 4% Hybrid, and 19% Remote job distribution.
Pharmacy Claims Adjudication Specialist

Pharmacy Claims Adjudication Specialist

Onco360

Scottsdale, AZ • Remote

$23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 12 days ago

Job description

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Scottsdale, AZ. This will be a Full-Time position. This is a remote hybrid opportunity, after onsite training period.
Shift time between 8am and 8pm.
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 August 31, 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.
  • Documents 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
#Company Values: Teamwork, Respect, Integrity, Passion
#IH

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