Appeals Specialist (Medical Claims)

About the Role

We are seeking a dedicated Appeals Specialist to join the Health and Welfare Claims Department, focusing primarily on managing member disputes and appeals. This role involves working collaboratively with various teams to process appeals and deliver exceptional service, especially for complex issues.

Key Responsibilities

• Evaluate and process appeals from members and providers, ensuring all actions comply with company policies and maintain accuracy.
• Interpret claims, benefits, contract terms, and relevant regulations to make sound appeal determinations.
• Work closely with internal departments to prepare and present cases for appeal resolution.
• Effectively communicate decisions and appeal outcomes to members, providers, and their representatives.
• Offer guidance on appeal processes to both members and providers.

Work Environment

This position follows a hybrid working arrangement with a requirement to be onsite three days per week. The role can be located in any of the company's Seattle, Mountlake Terrace, or Federal Way offices.

Candidate Profile

• Education: Bachelor's degree preferred, or an equivalent mix of education and relevant experience.
• Experience: Prior background in medical claims processing and/or handling appeals is highly desirable.
• Analytical Skills: Ability to review, understand, and interpret complex details within multiple plan descriptions.
• Problem-Solving: Strong aptitude for detailed analysis and resolving challenges effectively.
• Communication: Excellent verbal and written communication capabilities and strong interpersonal skills.
• Organizational Skills: Proven track record of managing multiple priorities efficiently and maintaining excellent organization.

About the Company

Northwest Administrators, Inc. is a leader in third-party administration of employee benefits, managing some of the largest multi-employer pension plans and numerous major health and welfare plans in the United States. Employees benefit from comprehensive training opportunities and a competitive benefits program.

Compensation and Benefits

• Hourly wage ranges from $31 to $42 based on experience and qualifications.
• Comprehensive medical, dental (including orthodontics), vision, prescription drug, disability, and life insurance plans.
• Optional benefits include health flexible spending accounts, dependent care assistance, and pet insurance.
• Robust 401(k) retirement plan with base contribution and company match.
• Paid time off includes 10 vacation days, 10 sick days, and 10 holidays annually.
• Emphasis on maintaining a healthy work-life balance.

Equal Employment Opportunity

The company is committed to equal opportunity in all employment decisions. Employment considerations are free from discrimination based on race, color, religion, national origin, gender identity or expression, age, disability, veteran status, and other protected categories. Reasonable accommodations are provided for applicants and employees with disabilities.