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Remote Claims Adjudicator Jobs (NOW HIRING)

Aon Corporation

Claims Specialist II

NY · Remote

$55K - $60K/yr

This position has 4 weeks of virtual training followed by a hybrid or 100% remote work schedule ... Prior claims adjudication experience. * Active General Adjustor license for home state or ...

Ascendo Resources

GAP Claims Processor

Tampa, FL · Remote

$25 - $27/hr

Claims Processor - GAP Claims Location: Remote (Florida, Iowa, Indiana, and North Carolina ... Thorough understanding of GAP products, claim calculations, and claims adjudication processes.

Imagenet

Healthcare Claims Team Lead - Remote

Tampa, FL · Remote

Remote Reporting to: Claims Supervisor About the Role We are seeking a highly driven Healthcare ... Imagenet provides claims processing services, including digital transformation, claims adjudication ...

Imagenet

Healthcare Claims Team Lead - Remote

Tampa, FL · On-site +1

Remote Reporting to: Claims Supervisor About the Role We are seeking a highly driven Healthcare ... Imagenet provides claims processing services, including digital transformation, claims adjudication ...

CareMed Specialty Pharmacy

$23/hr

This is a remote hybrid opportunity, after onsite training period. Shift time currently available ... The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for ...

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Remote Claims Adjudicator information

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$15

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$34

How much do remote claims adjudicator jobs pay per hour?

As of Jun 15, 2026, the average hourly pay for remote 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 the difference between Remote Claims Adjudicator vs Remote Claims Processor?

AspectRemote Claims AdjudicatorRemote Claims Processor
CredentialsTypically requires insurance or healthcare certifications, such as CPC or AHIPOften requires basic insurance knowledge, sometimes certifications but less specialized
Work EnvironmentRemote, independent review of claims, decision-making roleRemote, data entry and processing of claims
Employer & IndustryInsurance companies, healthcare providers, third-party administratorsInsurance companies, healthcare payers, claims processing centers

While both roles work remotely within the insurance industry, Remote Claims Adjudicators focus on reviewing and making decisions on claims, requiring specialized certifications. Remote Claims Processors handle data entry and processing tasks, often with less certification requirements. The roles differ mainly in decision-making responsibility and required credentials.

What are the key skills and qualifications needed to thrive as a Remote Claims Adjudicator, and why are they important?

To thrive as a Remote Claims Adjudicator, you need attention to detail, strong analytical abilities, and a solid understanding of insurance policies or healthcare claims, often backed by relevant experience or industry certification. Familiarity with claims processing software, document management systems, and secure communication tools is typically required. Exceptional written communication, time management, and problem-solving skills allow you to effectively resolve claims and collaborate remotely. These competencies ensure accurate, timely claims decisions and maintain compliance and customer satisfaction in a virtual work environment.

How does working remotely as a Claims Adjudicator impact daily collaboration and communication with the rest of the team?

As a Remote Claims Adjudicator, you'll typically collaborate with team members, supervisors, and related departments through digital platforms like email, instant messaging, and virtual meetings. While you may have fewer in-person interactions, most organizations provide structured check-ins and shared workflow tools to ensure smooth communication and continuous support. This setup allows you to ask questions, share updates, and resolve complex claims collaboratively, even from a distance. Proactive communication and staying organized are key to maintaining productivity and team cohesion in this virtual environment.

What are Remote Claims Adjudicators?

Remote Claims Adjudicators are professionals who review and process insurance claims from a remote location, such as their home or another off-site environment. Their main responsibilities include verifying claim information, ensuring policy compliance, determining claim validity, and calculating payment amounts. They communicate with policyholders, healthcare providers, or other relevant parties as needed, often using digital platforms and secure databases. Working remotely allows them flexibility while maintaining the accuracy and efficiency required in the claims adjudication process.
More about Remote Claims Adjudicator jobs
What cities are hiring for Remote Claims Adjudicator jobs? Cities with the most Remote Claims Adjudicator job openings:
What are the most commonly searched types of Claims Adjudicator jobs? The most popular types of Claims Adjudicator jobs are:
What states have the most Remote Claims Adjudicator jobs? States with the most job openings for Remote Claims Adjudicator jobs include:
What job categories do people searching Remote Claims Adjudicator jobs look for? The top searched job categories for Remote Claims Adjudicator jobs are:
Remote Claims Adjudicator jobs near you
Infographic showing various Remote Claims Adjudicator job openings in the United States as of June 2026, with employment types broken down into 2% Locum Tenens, 2% As Needed, 91% Part Time, and 5% Contract. Highlights an 81% Physical, 2% Hybrid, and 17% Remote job distribution, with an average salary of $55,623 per year, or $26.7 per hour.
Pharmacy Claims Adjudication Specialist

Pharmacy Claims Adjudication Specialist

Onco360

Scottsdale, AZ • Remote

$23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 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 currently available: 8:30 am-5:00 pm MST
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 July 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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