Appeals Specialist (Medical Claims)

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

Descripción de la vacante

The Appeals Specialist at Northwest Administrators, Inc. will support the Health and Welfare Claims Department, focusing on member disputes and appeals.

You will review appeals, analyze claims and plan descriptions, and prepare cases for resolution while communicating outcomes to members and providers. Hybrid work arrangement allows 3 days per week in-office in Seattle area; Bachelor’s degree or equivalent experience required, and medical claims/appeals experience preferred.

Formación

• 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.
• Strong analytical problem solving with great attention to detail.
• Excellent interpersonal, written and verbal communication skills.
• Exceptional organizational skills and ability to manage competing priorities.

Responsabilidades

• 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.

Conocimientos

Claims processing

Appeals

Analytical thinking

Communication

Organization

Educación

Bachelor’s degree or equivalent

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 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.