Job Description

Adjudication Specialist

  • 517601
  • Full-time


Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Courage, Teamwork

The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs and a recipient of multiple awards for excellence in workplace effectiveness and flexibility.

AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry.

Come join our dynamic and dedicated team.

Adjudication Specialist

Division of Fee For Service Management

Job Location:

Address:  801 E. Jefferson Street, Phoenix, AZ 85034

Posting Details:

Open until filled

Salary: $15.71 hourly 

Grade: 15

This position may offer the ability to work remotely within Arizona based upon the department's needs and continual meeting of expected performance measures.  

Job Summary:

The Division of Fee For Service Management is looking for a highly motivated individual to join our team as a Claims Specialist 2. This position is responsible for processing claims and must adjudicate in accordance with agency policies and procedures.

Major duties and responsibilities include but are not limited to: 

  • Adjudicates pended claims, requests medical documentation from providers, checks Docuware & Prepaid Medical Management Information Systems (PMMIS) for consent forms, eligibility of benefits (EOBs) and Third-Party Liability, reviews the history for duplicate claims/payments, identifies inappropriate billing patterns and forwards to appropriate unit, ensures medical documentation is included with submissions, supplements & links.
  • Ensure the system is appropriately processing claims, identifies problems/issues and notifies appropriate parties for resolution, identifies inappropriate billing patterns which are then reported to the Audit Unit or to the Agency's Fraud Unit for review.
  • Verifies eligibility of claims, using Agency's policies and procedures, coordinates claim that have Third Party Liability. 
  • Re-processes Prior Authorization Claims.
Knowledge, Skills & Abilities (KSAs):


  • AHCCCS Programs
  • AHCCCS Eligibility Groups
  • Administrative Rules and Regulations, AHCCCS Policies and Procedures


  • Intermediate computer skills
  • Data Entry *10 key by touch
  • Analyze specific problem areas and make recommendations for resolution 


  • Ability to work Virtual Office or telecommute or both 
  • Determine a pattern or inappropriate billing, which may indicate fraud
  • Analyze system issues, elevating concerns to management


  • One-year experience in insurance processing.


  • Experience working in adjudication and working knowledge of medical coding.
Pre-Employment Requirements:
  • Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees. 
  • Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.
  • Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.

Among the many benefits of a career with the State of Arizona, there are: 

  • 10 paid holidays per year
  • Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
  • A top-ranked retirement program with lifetime pension benefits 
  • A robust and affordable insurance plan, including medical, dental, life, and disability insurance 
  • Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
  • RideShare and Public Transit Subsidy 
  • A variety of learning and career development opportunities

For a complete list of benefits provided by The State of Arizona, please visit our benefits page


Lifetime Pension Benefit Program 

  • Administered through the Arizona State Retirement System (ASRS) 
  • Defined benefit plan that provides for life-long income upon retirement. 
  • Required participation for Long-Term Disability (LTD) and ASRS Retirement plan. 
  • Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program 

  • Voluntary participation.
  • Program administered through Nationwide.
  • Tax-deferred retirement investments through payroll deductions.
Contact Us:

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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