Hybrid Appeals Specialist - Claims & Disputes

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

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. You will review and process appeals, analyze claims and plan descriptions, collaborate with internal teams to prepare cases, and clearly communicate outcomes to members and providers.

Strong attention to detail and communication skills are essential. The role offers a hybrid schedule with 3 days per week in the office at Seattle-area

Formación

• Bachelor’s degree or combination of relevant education and experience.
• Medical claims processing and/or appeals experience highly preferred.
• Ability to interpret and retain detailed information from multiple plan descriptions.
• Strong analytical problem-solving skills with attention to detail.
• Excellent interpersonal, written and verbal communication skills.

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

Medical claims

Analytical

Communication

Organizational

Educación

Bachelor's degree

Descripción del empleo

Northwest Administrators, Inc. is seeking an Appeals Specialist to support the Health and Welfare Claims Department, focusing on member disputes and appeals. You will review and process appeals, analyze claims and plan descriptions, collaborate with internal teams to prepare cases, and clearly communicate outcomes to members and providers.

Strong attention to detail and communication skills are essential. The role offers a hybrid schedule with 3 days per week in the office at Seattle-area