Job Description
The Claims Adjudicator is responsible for reviewing, analyzing, and adjudicating medical and vision claims in accordance with plan documents, policies, and industry standards. This role requires interpreting complex benefit language and applying judgment to determine appropriate claim outcomes. A high degree of accuracy is needed for entering and verifying claim information in the system.
ResponsibilitiesReview, analyze, and adjudicate medical and vision claims in accordance with plan documents, policies, and industry standards.Interpret complex benefit language and apply judgment in determining appropriate claim outcomes.Enter and verify claim information in the system with a high degree of accuracy.Respond to telephone and written inquiries from providers, members, and internal departments in a timely and professional manner.Identify discrepancies, research data issues, and make necessary adjustments or referrals for resolution.Process electronic and paper claims and maintain data integrity across systems.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.Support continuous improvement by identifying process inefficiencies and contributing to best practice discussions.Essential SkillsClaims adjudicationMedical claim processingData entryInsurance knowledgeMedical billing and codingMinimum of 3–5 years of experience in medical claims adjudicationIn-depth knowledge of CPT, HCPCS, ICD-10, and CDTProficiency in interpreting benefit plan documents and EOBsFamiliarity with UB-04/CMS-1450 and CMS-1500 formsExperience with claim systems and TPA platformsExcellent communication and critical thinking skillsAbility to work independently, prioritize tasks, and meet processing benchmarksAdditional Skills & QualificationsHigh school diploma or equivalent required; associate degree or higher in a related field preferred6+ months of Medical Admin Experience, ideally with PremeraWork Environment
The work schedule is from 8 AM to 5 PM. The role requires working in a professional office environment, using computer systems for data entry and claim processing. The position offers a structured compensation and benefits package, including scheduled pay increases, a 401(k) with company match, employer-paid pension plan, and medical coverage starting after 4 months.
Job Type & Location
This is a Contract to Hire position based out of Spokane, Washington.
We reserve the right to pay above or below the posted wage based on factors unrelated to sex, race, or any other protected classification.
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. This temporary role may be eligible for the following:
Medical, Dental & Vision401(k)/RothBasic/Supplemental Life & AD&DShort and long-term disabilityHSA & DCFSATransportation benefitsEmployee Assistance ProgramCompany Paid Time off or State Sick LeavePay and Benefits
The pay range for this position is $19.00 - $26.00/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 23, 2025.
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\n\nAbout Aston Carter:\n
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.
\n\nThe 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.
\nIf 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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