Claims Adjudicator

Aston Carter•Spokane, WA

19h•$23 - $26•Onsite

About The Position

The Claims Adjudicator is responsible for reviewing, analyzing, and adjudicating medical and vision claims in accordance with plan documents, policies, and industry standards. The role involves interpreting complex benefit language and applying judgment to determine appropriate claim outcomes, ensuring data accuracy, and responding professionally to inquiries from providers, members, and internal departments.

Requirements

Minimum of 3–5 years of experience in medical claims adjudication.
Proficiency in medical billing and coding, including CPT, HCPCS, ICD-10, and CDT.
In-depth knowledge of interpreting benefit plan documents and EOBs.
Familiarity with UB-04/CMS-1450 and CMS-1500 forms.
Experience with claim systems and TPA platforms.
Excellent written and verbal communication skills.
Strong critical thinking skills.

Nice To Haves

High school diploma or equivalent required; associate degree or higher in a related field preferred.
6+ months of Medical Admin Experience, ideally with Premera.
Experience in data entry and documentation accuracy.
Ability to work independently and prioritize tasks effectively.

Responsibilities

Review and adjudicate medical and vision claims according to established guidelines.
Interpret complex benefit language to determine appropriate claim outcomes.
Enter and verify claim information with precision.
Respond promptly and professionally to inquiries from providers, members, and internal departments.
Identify discrepancies, research data issues, and make necessary adjustments or referrals for resolution.
Process electronic and paper claims while maintaining data integrity.
Generate and review provider correspondence, including system-generated letters and explanation of benefits (EOBs).
Collaborate with internal teams to support compliance, audit readiness, and customer satisfaction goals.
Contribute to continuous improvement by identifying process inefficiencies and participating in best practice discussions.