Appeals Specialist (Medical Claims)

Appeals Specialist (Medical Claims)

The Appeals Specialist will assist in the operations of the Health and Welfare Claims Department and will primarily focus on member disputes and appeals.

Review and process member and provider appeals, ensuring accuracy and adherence to policies

Analyze claims, benefits, contracts and regulations to make informed appeal decisions

Collaborate with internal teams to prepare and present appeal cases for resolution

Clearly communicate appeal outcomes to members, providers and representatives

Provide guidance and support to members and providers on appeal procedures

This position has a hybrid work schedule with 3 days per week in the office. The position can be based in our Seattle, Mountlake Terrace or Federal Way office.

Bachelor's degree or combination of relevant education and experience

Medical claims processing and/or appeals experience highly preferred

Interpret and retain detailed information from multiple plan descriptions

Problem solver. Strong analytical problem solver with great attention to detail

Excellent interpersonal, written and verbal communication skills

Exceptional organizational skills and ability to manage competing priorities

Northwest Administrators, Inc. is an industry leader in third-party administration of employee benefits. We administer one of the largest multi-employer pension plans in the country, along with numerous large health and welfare plans. As part of our team, you will benefit from many training and development opportunities and can expect a better-than-market benefits package.

Hourly rate range of $30.70 - $41.54 per hour (dependent on experience & qualifications)

Medical, dental (w/orthodontia), vision, Rx benefits, disability & life insurance

Optional benefits: health flex spending, dependent care assistance & pet insurance

Generous 401(k) plan with company base contribution & match

Paid Vacation (10 days), Sick Leave (10 days) and Holidays (10 days)

Work-life balance

NWA is proud to be an Equal Employment Opportunity employer. All employment decisions are based on business needs, job requirements and individual qualifications, without regard to race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age, physical or mental disability, marital status, amnesty, veteran status, citizenship, family medical history or genetic information or any other characteristic protected by local, state, or federal laws. NWA prohibits any discrimination or harassment based on any of these characteristics.

We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact Human Resources at View email address on click.appcast.io to request accommodation.