Medical Claims Auditor (On-Site)

Northwest Administrators, Inc; Seattle (WA); Hybrid; USD 64,000 - 86,000; Full time

Benefits offered by this job

Healthcare benefits

401(k) plan with employer match

Paid vacation, sick leave and holidays

Hybrid schedule after training

On-site training in Seattle (Eastlake)

Job summary

Northwest Administrators, Inc. in Seattle seeks a Health & Welfare Claims Auditor to review the work of Health and Welfare Claims Processors, collaborating with auditors, vendors, account executives, supervisors and medical consultants.

Responsibilities include internal audits, designing training plans, conducting sessions for new processors, training on plan and system changes, responding to questions, performing large-dollar audits and coordinating vendor interactions with PPOs.

Qualifications

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

Responsibilities

• Perform internal audits of 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.
• Coordinate vendor interaction with PPOs and benefit providers.

Skills

Verbal communication

Written communication

Interpersonal skills

Organizational skills

Microsoft Office

Education

Bachelor's degree or equivalent experience

Tools

Microsoft Office

Job description

Are you a skilled communicator with strong writing abilities and deep, hands-on experience processing medical claims? Do you enjoy applying your claims expertise to work one-on-one or in small group settings, to help others strengthen their accuracy, compliance, and performance? If so, you may be the ideal candidate for our Claims Auditor position within our Health & Welfare group.

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
• Coordinate vendor interaction with specific PPOs and benefit providers

NOTE: This position will be on-site in our Seattle office (Eastlake) during the training period. A hybrid work schedule with 3 days per week in office is available, after the completion of training.

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

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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