Appeals Specialist (Medical Claims)

Northwest Administrators, Inc.; Federal Way (WA); Híbrido; USD 42.000 - 57.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, vision, Rx

Disability & life insurance

401(k) with company match

Paid Vacation (10 days) and Sick Leave

Holidays (10 days)

Descripción de la vacante

Northwest Administrators, Inc. is seeking an Appeals Specialist to support the Health and Welfare Claims Department, focusing on member disputes and appeals. A bachelor’s degree or combination of relevant education and experience is preferred, with strong analytical and communication skills required.

The role offers a hybrid schedule with 3 days per week in the office, and can be based in Seattle, Mountlake Terrace, or Federal Way. We provide competitive benefits and opportunities for growth.

Formación

• 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 multiple plan descriptions.
• Excellent interpersonal, written and verbal communication skills.

Responsabilidades

• Review and process member and provider appeals with accuracy.
• Analyze claims, benefits, contracts and regulations to decide appeal decisions.
• Collaborate with internal teams to present appeal cases for resolution.
• Clearly communicate appeal outcomes to members, providers and representatives.
• Provide guidance and support on appeal procedures.

Educación

Bachelor's degree

Combination of education and experience

Analytical thinking

Problem solving

Communication skills

Organizational skills

Interpersonal skills

Descripción del empleo

Do you enjoy working with a great team of people? Do you provide exceptional service even when having to solve issues that may be complex and difficult? Does the phrase “details matter” describe your approach to everything? If you answered “YES” then you may be the person we’re seeking for our Appeals Specialist position!

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

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.

Who you are...

• Educated. Bachelor’s degree or a combination of relevant education and experience
• Experienced. Medical claims processing and/or appeals experience highly preferred
• Analytical. 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...

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. See what our associates are saying about us at Northwest Administrators Inc. | Careers (nwadmin.com)

If hired, you can expect...

• 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 [e-mail] to request accommodation.