Job Details

Claims Adjudicator

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.

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.

Essential Skills

• 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.

Additional Skills & Qualifications

• High school diploma or equivalent required; associate degree or higher in a related field preferred.
• 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.

Work Environment

The work schedule is from 8am to 5pm, with an early departure at 4pm on Fridays. The company offers a great culture with fun events to engage employees.

Job Type & Location

This is a Contract to Hire position based out of Spokane, WA.

Pay and Benefits

The pay range for this position is $23.00 - $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 Apr 14, 2026.