Appeals Specialist (Medical Claims)

Northwest Administrators • Mountlake Terrace, WA

1d • Hybrid

About The Position

The Appeals Specialist assists the Health and Welfare Claims Department, focusing primarily on member disputes and appeals. The role reviews and processes member and provider appeals, analyzes claims and related plan information to make informed decisions, works with internal teams to resolve appeal cases, communicates outcomes, and provides guidance on appeal procedures. This position has a hybrid schedule with three days per week in the office and may be based in Seattle, Mountlake Terrace, or Federal Way.

Requirements

• Bachelor’s degree or a combination of relevant education and experience.
• Strong ability to interpret and retain detailed information from multiple plan descriptions.
• Strong analytical problem-solving skills and attention to detail.
• 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, 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