Appeals Specialist (Medical Claims)

Northwest Administrators • Federal Way, WA

1d • Hybrid

About The Position

The Appeals Specialist assists in the operations of the Health and Welfare Claims Department, primarily focusing on member disputes and appeals. The position has a hybrid schedule, with three days per week in the office, and can be based in the Seattle, Mountlake Terrace, or Federal Way office.

Requirements

• A 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.
• Paid vacation (10 days), sick leave (10 days), and holidays (10 days).
• Training and development opportunities.
• Work-life balance.

What This Job Offers

• Job Type: Full-time