Appeals Specialist (Medical Claims)

Northwest Administrators, Inc. • Mountlake Terrace, WA

3d • $31 - $42 • Hybrid

About The Position

The Appeals Specialist assists the Health and Welfare Claims Department, primarily focusing on member disputes and appeals. The role reviews and processes member and provider appeals, analyzes claims, benefits, contracts, and regulations to inform appeal decisions, collaborates with internal teams to prepare and present cases for resolution, communicates appeal outcomes, and provides guidance on appeal procedures. The position has 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 great 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.
• Generous 401(k) plan with company base contribution and match.
• Paid vacation (10 days), sick leave (10 days), and holidays (10 days).
• Training and development opportunities.
• Work-life balance.
• Better-than-market benefits package.

What This Job Offers

• Job Type: Full-time