Appeals Specialist (Medical Claims)

Do you enjoy working with a great team of people? Do you provide exceptional service when solving complex or difficult issues? Does the phrase “details matter” describe your approach to work? If you answered “YES,” this Appeals Specialist position may be a great fit for you. Availability: 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. Monday-Friday, normal business hours. What you'll be doing... 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 Who you are... Educated. Bachelor's degree or combination of relevant education and experience Experienced. Medical claims processing and/or appeals experience is preferred, specifically on the payor side. Provider-side experience alone may not meet this requirement. Analytical. Able to interpret and retain detailed information from multiple plan descriptions. Problem Solver. Strong analytical problem solver with great attention to detail Communicator. Excellent interpersonal, written and verbal communication skills Organized. Exceptional organizational skills and ability to manage competing priorities Who we are... This firm is an industry leader in third-party administration of employee benefits. It administers one of the largest multi-employer pension plans in the country, along with numerous large health and welfare plans. As part of the team, you will benefit from many training and development opportunities and can expect a better-than-market benefits package. If hired, you can expect: 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 CampusPoint is an Equal Opportunity Employer. All aspects of employment, including the decision to hire, promote, discipline, or discharge, will be based on merit, competence, performance, and business needs. We do not discriminate on the basis of race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law. If you need assistance or an accommodation due to a disability, you may contact us at View email address on click.appcast.io or 1+206-783-9200 (ask to speak with an HR representative). The process is outlined in CampusPoint’s ADA Policy. #J-18808-Ljbffr