Job Title: Claims Adjudicator
Job Description

We are seeking a detail-oriented and experienced Claims Adjudicator to accurately and timely evaluate, regulate, and adjudicate medical claims. The role involves researching and responding to telephone and written inquiries, entering and verifying claims into the system, and sending system-generated letters to providers. The ideal candidate will review electronic claims, process data, and make payment adjustments based on consumer service referrals and audited data inaccuracies. This position requires excellent judgment, interpretation of medical claim data and benefit language, and the ability to resolve computer-generated conditions to determine correct payment.

ResponsibilitiesEvaluate, 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 adjust claim payments resulting from consumer service referrals and audited data inaccuracies.Exercise excellent judgment and interpret medical claim data and benefit language.Process responses accordingly.Work collaboratively to achieve standards of timely, well-organized, and accurate claim processing.Resolve computer-generated conditions and determine correct payment.Essential SkillsClaims adjudicationMedical claims processingData entryInsuranceMedical billing and coding6+ months of medical administration experienceWritten and verbal communicationAdditional Skills & QualificationsHigh school diploma, GED, or equivalent work experienceOutstanding knowledge of claims processing and medical terminologySuperb data entry skills with high accuracyStrong written and spoken communication skillsKnowledge of insurance procedures and relevant computer softwareKnowledge of physician practice and hospital coding, billing, and medical terminology (CPT, HCPCS, ICD-10, CDT)Experience with UB/institutional (CMS-1450) and/or professional (CMS 1500) claimsAbility to work with minimal supervisionCreative thinker with strong problem resolution skills, specifically related to healthcare claim adjudicationAbility to work closely with other departmentsWork Environment

The position operates on a standard schedule from 8am to 5pm. Employees will enjoy union benefits upon conversion, 10 paid holidays per year, and a family-owned business feel, which is rare in the industry.

Pay and Benefits

The pay range for this position is $19.00 - $20.00

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\n
• Critical Illness, Accident, and Hospital\n
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available\n
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)\n
• Short and long-term disability\n
• Health Spending Account (HSA)\n
• Transportation benefits\n
• Employee Assistance Program\n
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully onsite position in Spokane,WA.

Application Deadline

This position will be accepting applications until Jan 29, 2025.

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\n \n About 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 Diversity, Equity & Inclusion\n

At Aston Carter, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

\n Hiring diverse talent\n Maintaining an inclusive environment through persistent self-reflection\n Building a culture of care, engagement, and recognition with clear outcomes\n Ensuring growth opportunities for our people\n

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.

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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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