Appeals Specialist (Medical Claims)

Northwest Administrators • Seattle, WA

6d • Hybrid

About The Position

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.

Requirements

• 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
• 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

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

Benefits

• Medical, dental (w/orthodontia), vision, Rx benefits, disability & life insurance
• 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)
• Holidays (10 days)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level