Hybrid Appeals & Claims Specialist

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

Benefits offered by this job

Health benefits

Dental & vision

Rx benefits

Disability & life insurance

401(k) plan with match

Paid vacation & holidays

Work-life balance

Job summary

Northwest Administrators, Inc. is seeking an Appeals Specialist to support the Health and Welfare Claims Department. You will focus on member disputes and appeals, reviewing and processing appeals and collaborating with internal teams to present cases for resolution.

The role requires a Bachelor’s degree or equivalent experience, strong analytical skills, and excellent communication. The position offers a hybrid schedule with three days in the office in the Seattle area.

Qualifications

• Bachelor’s degree or equivalent experience.
• Strong analytical problem-solving abilities.
• 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

Analytical

Problem solver

Communicator

Organized

Education

Bachelor's degree

Job description

Northwest Administrators, Inc. is seeking an Appeals Specialist to support the Health and Welfare Claims Department. You will focus on member disputes and appeals, reviewing and processing appeals and collaborating with internal teams to present cases for resolution.

The role requires a Bachelor’s degree or equivalent experience, strong analytical skills, and excellent communication. The position offers a hybrid schedule with three days in the office in the Seattle area.