Appeals Specialist (Medical Claims)

Do you enjoy working with a great team of people? Do you provide exceptional service even when having to solve issues that may be complex and difficult? Does the phrase “details matter” describe your approach to everything? If you answered “YES” then you may be the person we’re seeking for our Appeals Specialist position!

What you'll be doing...

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.

Who you are...

Educated. Bachelor’s degree or combination of relevant education and experience

Experienced. Medical claims processing and/or appeals experience highly preferred

Analytical. Interpret and retain detailed information from multiple plan descriptions

Problem Solver. Strong analytical problem solver with great attention to detail

Communicator. Excellent interpersonal, written and verbal communication skills

Organized. Exceptional organizational skills and ability to manage competing priorities

Who we are...

Northwest Administrators, Inc. is an industry leader in third-party administration of employee benefits. We administer one of the largest multi-employer pension plans in the country, along with numerous large health and welfare plans. As part of our team, you will benefit from many training and development opportunities and can expect a better-than-market benefits package. See what our associates are saying about us at Northwest Administrators Inc. | Careers (nwadmin.com)

If hired, you can expect...

Hourly rate range of $30.70 - $41.54 per hour (dependent on experience & qualifications)

Medical, dental (w/orthodontia), vision, Rx benefits, disability & life insurance

Optional benefits: 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) and Holidays (10 days)

Work-life balance

Equal Employment Opportunity

NWA is proud to be an Equal Employment Opportunity employer. All employment decisions are based on business needs, job requirements and individual qualifications, without regard to race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age, physical or mental disability, marital status, amnesty, veteran status, citizenship, family medical history or genetic information or any other characteristic protected by local, state, or federal laws. NWA prohibits any discrimination or harassment based on any of these characteristics.

We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact Human Resources at [email protected] to request accommodation.

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