Job Description

Claims Adjudicator

As a Claims Adjudicator, you will be responsible for accurately and promptly evaluating, regulating, and adjudicating medical claims. You will also research and respond to telephone and written inquiries, enter and verify claims into the system, and send system-generated letters to providers. Your role will involve reviewing electronic claims and processing data as required by the claims system, making payment adjustments based on consumer service referrals, and auditing data inaccuracies. You will be expected to exercise excellent judgment, interpret medical claim data and benefit language, and process responses accordingly. Collaboration with colleagues to achieve standards of timely, well-organized, and accurate claim processing is essential, as is the ability to resolve computer-generated conditions and determine correct payment.

Responsibilities:

• Evaluate, regulate, and adjudicate medical claims accurately and timely.
• Research and respond to telephone and written inquiries.
• Enter and verify claims into the system.
• Send system-generated letters to providers.
• Review electronic claims and process data as required by the claims system.
• Research and implement claim payment adjustments resulting from consumer service referrals.
• Audit data inaccuracies as detected.
• Exercise excellent judgment and interpret medical claim data and benefit language.
• Collaborate to achieve standards of timely, well-organized, and accurate claim processing.
• Resolve computer-generated conditions and determine correct payment.

Essential Skills:

• Claims adjudication
• Medical claims processing
• Insurance knowledge
• Medical billing and coding
• Data entry proficiency
• 6+ months of medical admin experience
• Written and verbal communication skills

Additional Skills & Qualifications:

• High school diploma, GED, or equivalent work experience.
• Outstanding knowledge of claims processing and medical terminology.
• Superb data entry skills with high accuracy.
• Knowledge of insurance procedures and pertinent computer software.
• Knowledge of physician practice and hospital coding, billing, and medical terminology.
• Experience with UB/institutional (CMS-1450) and/or professional (CMS 1500) claims.
• Ability to work with minimal supervision.
• Creative thinker with problem resolution skills specifically related to healthcare claim adjudication.

Work Environment:

The work environment operates from 8 AM to 5 PM, offering union benefits upon conversion and 10 paid holidays per year. The company provides a family-owned business feel, which is rare for the industry.

Pay and Benefits:

The pay range for this position is $19.00 - $20.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision; Critical Illness, Accident, and Hospital; 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available; Life Insurance (Voluntary Life & AD&D for the employee and dependents); Short and long-term disability; Health Spending Account (HSA); Transportation benefits; Employee Assistance Program; Time Off/Leave (PTO, Vacation or Sick Leave).

Workplace Type:

This is a fully onsite position in Spokane, WA.

Application Deadline:

This position is anticipated to close on Aug 20, 2025.

About Aston Carter:

Aston Carter provides world-class corporate talent solutions to thousands of clients across the globe. Specialized in accounting, finance, human resources, talent acquisition, procurement, supply chain, and select administrative professions, we extend the capabilities of industry-leading companies. We draw on our deep recruiting expertise and expansive network to meet the evolving needs of our clients and talent community with agility and excellence. With offices across the U.S., Canada, Asia Pacific and Europe, Aston Carter serves many of the Fortune 500. We are proud to be a ClearlyRated Best of Staffing double diamond winner for both client and talent service. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email astoncarteraccommodation@astoncarter.com for other accommodation options.

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