Appeals Specialist (Medical Claims)
Posted 5 days ago
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...
- Bachelor’s degree or combination of relevant education and experience
- Medical claims processing and/or appeals experience highly preferred
- Interpret and retain detailed information from multiple plan descriptions
- Problem Solver. Strong analytical problem solver with great attention to detail
- Excellent interpersonal, written and verbal communication skills
- 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.
Northwest Administrators Inc. | Privacy Policy (nwadmin.com)
About Northwest Administrators, Inc. (NWA) Since 1958, Northwest Administrators, Inc. (NWA) has delivered trusted, high-quality employee benefit plan administration and benefit claim processing services across the Western United States. With primary offices in Seattle, WA; Portland, OR; Brisbane and Pasadena, CA; and Las Vegas, NV, we proudly support organizations and their members with responsive, efficient, and customized solutions. What We Do NWA partners with Taft-Hartley trusts and multiple-employer (association) health and retirement plans, serving several hundred thousand participants. Our comprehensive suite of services gives clients the flexibility to build and manage benefit programs that truly meet their needs, including: - Benefit claim processing for medical, dental, vision, prescription drug, and weekly disability plans -Employer reporting and eligibility services -Retirement plan administration for both defined benefit and defined contribution plans -Investment and cash management services -Multi-employer trust and association administration, including full financial accounting -COBRA and HIPAA administration -A managed vision program (NBN Vision) featuring one of the Northwest’s most extensive provider networks NWA remains committed to reliability, accuracy, and exceptional client service—helping organizations deliver benefits their participants can count on.
Key team members
Scott LaChute
Tony Chao, MBA
Lori Inuzuka
Sally Zapata
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