Appeals Specialist (Medical Claims)

Northwest Administrators • Seattle, WA

1d • Hybrid

About The Position

The Appeals Specialist assists with operations in the Health and Welfare Claims Department, primarily handling member disputes and appeals. The role reviews and processes member and provider appeals, analyzes claims and governing plan information to support appeal decisions, collaborates with internal teams to resolve cases, communicates outcomes, and guides members and providers through appeal procedures. The position follows a hybrid schedule with three days per week in the office and may be based in the Seattle, Mountlake Terrace, or Federal Way office.

Requirements

• Bachelor’s degree or a combination of relevant education and experience.
• Strong analytical problem-solving skills and attention to detail.
• Ability to interpret and retain detailed information from multiple plan descriptions.
• Excellent interpersonal, written, and verbal communication skills.
• Exceptional organizational skills and ability to manage competing priorities.

Nice To Haves

• Medical claims processing and/or appeals experience is highly preferred.

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 (including orthodontia), vision, prescription drug, disability, and life insurance benefits.
• Optional health flexible spending, dependent care assistance, and pet insurance.
• 401(k) plan with company base contribution and match.
• 10 days of paid vacation, 10 days of sick leave, and 10 paid holidays.
• Training and development opportunities.
• Work-life balance.

What This Job Offers

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