Appeals Specialist - Health & Welfare (Hybrid)

Northwest Administrators, Inc; Seattle (WA); Hybrid; USD 42,000 - 57,000; Full time

Benefits offered by this job

Medical benefits

Dental & vision benefits

Disability & life insurance

401(k) with company match

Paid vacation

Sick leave

Holidays

Health flex spending

Dependent care assistance

Pet insurance

Work-life balance

Job summary

Northwest Administrators Inc. is seeking an Appeals Specialist to assist in the Health and Welfare Claims Department, focusing on member disputes and appeals.

The role involves reviewing appeals, analyzing claims and plan descriptions, and collaborating with internal teams to present cases for resolution. The position offers a hybrid schedule with 3 days in the office and can be based in Seattle, Mountlake Terrace, or Federal Way.

Qualifications

• Bachelor’s degree or combination of relevant education and experience.
• Medical claims processing and/or appeals experience preferred.
• Ability to interpret and retain detailed information from plan descriptions.
• 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.

Responsibilities

• 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.

Skills

Medical claims processing

Appeals experience

Analytical

Problem solving

Communication

Organization

Attention to detail

Education

Bachelor’s degree or equivalent

Job description

Northwest Administrators Inc. is seeking an Appeals Specialist to assist in the Health and Welfare Claims Department, focusing on member disputes and appeals.

The role involves reviewing appeals, analyzing claims and plan descriptions, and collaborating with internal teams to present cases for resolution. The position offers a hybrid schedule with 3 days in the office and can be based in Seattle, Mountlake Terrace, or Federal Way.