> Markdown version of [/jobs/ext/2627643-adjudication-specialist-remote](https://www.wearedevelopers.com/jobs/ext/2627643-adjudication-specialist-remote). Every page supports `.md` or `Accept: text/markdown`. Links point to the HTML versions so they work for humans too. Agent guide: [/agents.md](https://www.wearedevelopers.com/agents.md). --- # Adjudication Specialist - Remote - **Company:** Polaris Inc - **Location:** Fort Lauderdale, FL, United States (Remote available) - **Contract:** Permanent contract - **Skills:** Microsoft Word, Microsoft Excel, Microsoft Outlook, Computer Literacy - **Published:** August 3, 2026 - **Apply:** https://www.indeed.com/viewjob?jk=49c134c4c045dceb ## About the Role To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions., * Able to read, write, speak, and understand the English language * Able to retain a large amount of information and apply that knowledge to related situations * Able to work in a fast-paced environment * Basic computer knowledge skills required * Basic math and analytical skills * Experience with alpha-numeric data entry * Proficient in Microsoft Word, Excel, and Outlook required * Customer Service * Results-oriented * Good organization/Attention to detail * Reliable * Problem solver * Able to work various shifts and days * Adaptability to an ever-changing environment, * High School diploma or equivalent required * Minimum of one (1) or more years working as a pharmacy technician in a retail environment required (long-term care pharmacy preferred) * Framework LTC & General computer knowledge & 10-key Number Entry preferred ## Description The Adjudication Specialist manages a portfolio of rejected pharmacy claims, ensuring timely billing and maximum payer reimbursement. They prioritize customer needs, maintain courteous communication, and build effective relationships with colleagues and clients. Their goal is to uphold customer trust and enhance our services., * Manage and Identify Claims Portfolio: + Review and evaluate insurance claims to determine the extent of the insurer's liability, adhering to policy provisions and state and federal regulations. + Authenticate claimants and verify the accuracy of claim submission documents to prevent fraud and ensure compliance with policy terms. * Resolve Rejected Claims: * Calculate benefit payments and approve claim settlements based on policy coverage and assessment findings. * Coordinate with healthcare providers, repair services, or other parties to obtain additional documentation necessary for claim resolution. * Effective Communication and Risk Management: * Negotiate settlements with claimants or their representatives in cases of disputed claims. * Monitor and resolve revenue risks associated with payer setup, billing, rebilling, and reversal processes. * Policy Interpretation and Compliance: * Interpret and apply complex insurance policy language to diverse claim scenarios. * Provide detailed explanations to claimants regarding the adjudication process, claim denials, or settlement offers * Additional Responsibilities: * Implement alternative dispute resolution methods when conventional negotiation does not achieve a settlement. * Complete necessary payer paperwork, including prior authorization forms and manual billing. * Handle non-standard order entry situations as required. * Support training needs within the team. * Duties may vary depending on business needs and operational context. ## Related Videos - [Why Your Next Best Talent Might Not Be in Your Neighborhood](https://www.wearedevelopers.com/videos/1861-why-your-next-best-talent-might-not-be-in-your-neighborhood) - [Developing the Rich Text Editor for DeepL.com](https://www.wearedevelopers.com/videos/1172-developing-the-rich-text-editor-for-deepl-com) - [In-depth .NET Azure Functions: Isolated mode, performance and durable AI agents](https://www.wearedevelopers.com/videos/100207-in-depth-net-azure-functions-isolated-mode-performance-and-durable-ai-agents) - [Claude, MCP and n8n, or: How to Automate Your Day with AI-powered Workflows](https://www.wearedevelopers.com/videos/2043-claude-mcp-and-n8n-or-how-to-automate-your-day-with-ai-powered-workflows) - [From Syntax to Singularity: AI’s Impact on Developer Roles](https://www.wearedevelopers.com/videos/900-from-syntax-to-singularity-ai-s-impact-on-developer-roles) - [From Tables to Graphs in Minutes: Supercharging Kusto Graph Analytics with AI-Powered Development](https://www.wearedevelopers.com/videos/1543-from-tables-to-graphs-in-minutes-supercharging-kusto-graph-analytics-with-ai-powered-development) ## Related Articles - [Best Paying Remote Jobs](https://www.wearedevelopers.com/magazine/255-best-paying-remote-jobs) - [Remote Work: Best Practices for Developers](https://www.wearedevelopers.com/magazine/315-remote-work-best-practices-for-developers) - [Fully Remote Software Engineer Jobs](https://www.wearedevelopers.com/magazine/447-fully-remote-software-engineer-jobs) - [Mastering Remote Work: Tips for Developers](https://www.wearedevelopers.com/magazine/558-mastering-remote-work-tips-for-developers) - [Best Job Boards for Remote Work for Developers](https://www.wearedevelopers.com/magazine/290-best-job-boards-for-remote-work-for-developers) - [Data Analyst Salary in the UK](https://www.wearedevelopers.com/magazine/278-data-analyst-salary-in-the-uk)