Medical Claims Auditor (Hybrid)

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

Job summary

Northwest Administrators, Inc. in Washington state seeks a Health and Welfare Claims Auditor to review the work of Health and Welfare Claims Processors. You will collaborate with auditors, vendors, account executives, and managers to improve accuracy and compliance.

The role requires hands-on medical/dental claims processing experience, auditing and training skills, and strong written communication. Hybrid work is available with office days in Seattle area.

Qualifications

• Bachelor's degree preferred or equivalent combination of education and experience.
• Medical & dental claims processing experience required.
• Auditing and training experience preferred.
• Strong written and verbal communication skills.
• Proficient with Microsoft Office Suite.

Responsibilities

• Perform internal audits of Health and Welfare Claims Processors’ work.
• Design and deliver training plans for Claims Processors.
• Conduct training sessions for new Claims Processors.
• Respond to day-to-day referral questions and handle audits.
• Prepare written claim processing guideline materials.
• Coordinate vendor interactions with PPOs and benefit providers.

Skills

Medical & Dental Claims processing

Auditing

Training

Written communication

Verbal communication

Microsoft Office

Education

Bachelor's degree or equivalent

Tools

Microsoft Office Suite

Job description

• Prepare written claim processing guideline materials

Are you a skilled communicator with strong writing abilities and deep claims experience? Do you have actual hands-on experience processing medical claims, from beginning to end? Do you enjoy applying your medical claims expertise to work one-on-one, or in small group settings, to help others strengthen their accuracy, compliance, and performance? If you answered 'YES' to these questions, then you may be the person we're seeking for our Claims Auditor position!

What You'll Be Doing…

As a Health and Welfare Claims Auditor, the main focus will be to review the work completed by the Health and Welfare Medical, Dental, Vision, Time Loss and Life Claims Processors. This position requires collaboration with other auditors, outside vendors, account executives, department supervisors and managers, and medical consultants.

Primary Responsibilities For This Position Include

• Perform internal audits of our Health and Welfare Claims Processors' work
• Design and implement training plans for Claims Processors
• Conduct training sessions for groups of new Claims Processors
• Train and cross-train on plan, system and procedural changes
• Respond to day-to-day referral questions
• Perform random and large dollar claims audits
• Prepare written claim processing guideline materials
• Coordinate vendor interaction with specific PPOs and benefit providers

This position has a hybrid work schedule with 3 days per week in the office, after completion of training. The position can be based in our Seattle, Mountlake Terrace or Federal Way office.

Who You Are…

• Educated. Bachelor's degree preferred or equivalent combination of education & experience
• Experienced. Medical & Dental Claims processing; auditing/training experience preferred
• Organized. Able to prioritize work, multi-task and work independently
• Communicator. Excellent verbal, written and interpersonal communication skills
• Technically Savvy. Intermediate level experience using Microsoft Office Suite of tools

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 upon 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 employer base contribution and match
• Paid Vacation (10 days), Sick Leave (10 days) and Holidays (10 days)
• Collaborative team environment
• Work-life balance

Equal Employment Opportunity

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.

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