ZipRecruiter

Log In

2

Remote Adjudication Specialist Jobs (NOW HIRING)

RemX

Be Seen First

REMOTE Medical Claims Specialists $19/hr

Irving, TX · Remote

$19/hr

Remote Medical Claims Specialist Manager * Pay: $19/hr. Weekly Pay plus Benefits * Paid Training ... Insurance verification and claim adjudication or medical billing. * Experience or knowledge of ICD ...

TEKsystems

Denials Specialist

Jacksonville, FL · Remote

$26/hr

Denial Specialist REMOTE | $26.00 USD/hour Highlights: • Industry: Healthcare Revenue Cycle • ... claim adjudication outcomes, and reimbursement guidelines to resolve complex claim issues. • ...

next page

Showing results 1-20

All Jobsremote JobsFinance and Insurance JobsInsurance JobsInsurance Claims Specialist JobsRemote Adjudication Specialist Jobs

Remote Adjudication Specialist information

See salary details

$13

$27

$44

How much do remote adjudication specialist jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for remote adjudication specialist in the United States is $27.40, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $30.77 per hour, depending on experience, location, and employer.

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

AspectRemote Adjudication SpecialistClaims Processor
CredentialsTypically requires healthcare or insurance-related certificationsOften requires basic insurance or administrative training
Work EnvironmentRemote, healthcare or insurance company settingsRemote or office-based, insurance companies or healthcare providers
Job FocusReviewing and making decisions on insurance claimsProcessing and entering insurance claims data

The Remote Adjudication Specialist primarily reviews and makes decisions on insurance claims, requiring specialized knowledge and certifications. In contrast, Claims Processors focus on data entry and processing of claims, often with less specialized credentials. Both roles are common in insurance and healthcare industries and often work remotely, but their core responsibilities differ significantly.

More about Remote Adjudication Specialist jobs

What cities are hiring for Remote Adjudication Specialist jobs?

Cities with the most Remote Adjudication Specialist job openings:

What are the most commonly searched types of Adjudication Specialist jobs?

The most popular types of Adjudication Specialist jobs are:

What states have the most Remote Adjudication Specialist jobs?

States with the most job openings for Remote Adjudication Specialist jobs include:

What job categories do people searching Remote Adjudication Specialist jobs look for?

The top searched job categories for Remote Adjudication Specialist jobs are:

Remote Adjudication Specialist jobs near you
Infographic showing various Remote Adjudication Specialist job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $56,988 per year, or $27.4 per hour.

Pharmacy Claims Adjudication Specialist

Onco360

Salt Lake City, UT • Remote

$23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 15 hours 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

What Onco360 employees say

Pay

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply