Claims Adjudicator

Aston Carter•Spokane, WA

6d•$23 - $26•Onsite

About The Position

As a Claims Adjudicator, you will review, analyze, and adjudicate medical and vision claims in accordance with plan documents, policies, and industry standards. You will interpret complex benefit language and apply judgment in determining appropriate claim outcomes. Your role involves entering and verifying claim information in the system with a high degree of accuracy and responding to telephone and written inquiries from providers, members, and internal departments in a timely and professional manner.

Requirements

In-depth knowledge of medical billing and coding, including CPT, HCPCS, ICD-10, and CDT.
Proficiency in interpreting benefit plan documents and EOBs.
Familiarity with UB-04/CMS-1450 and CMS-1500 forms.
Experience with claim systems and TPA platforms.
Excellent communication and critical thinking skills.
Ability to work independently and meet processing benchmarks.
High school diploma or equivalent required; associate degree or higher in a related field preferred.

Nice To Haves

Ideal candidate has 6+ months of Medical Admin Experience, preferably with Premera.
Proficiency in medical billing and coding.
Familiarity with data entry, Premera, CPT, CMS 1500, HCPCS, ICD-10, and Aetna.
Strong written and verbal communication skills.

Responsibilities

Review, analyze, and adjudicate medical and vision claims.
Interpret complex benefit language to determine claim outcomes.
Enter and verify claim information accurately.
Respond to inquiries from providers, members, and internal departments.
Identify and resolve discrepancies and data issues.
Process electronic and paper claims while maintaining data integrity.
Generate and review provider correspondence, including EOBs.
Collaborate with internal teams to support compliance and customer satisfaction.
Contribute to continuous improvement by identifying process inefficiencies.