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.
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
Problem solver. Strong analytical problem solver with great attention to detail
Excellent interpersonal, written and verbal communication skills
Exceptional organizational skills and ability to manage competing priorities
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.
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 HR@nwadmin.com to request accommodation.
Appeals Specialist (Medical Claims) • Federal Way, WA, United States
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