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Northwest AdministratorsPosted 1 month ago

Appeals Specialist (Medical Claims)

$63,856–$86,403 year

HybridFederal Way, Washington, United States

Full TimeBachelors DegreeMediumEmployee Benefits Administration

Job Summary

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, then clearly communicate outcomes to members, providers, and representatives. Provide guidance and support to stakeholders on appeal procedures. This hybrid role includes three days per week in the office, with locations in Seattle, Mountlake Terrace, or Federal Way.

Required Qualifications

  • Bachelor's degree or a combination of relevant education and experience

Desired Qualifications

  • Medical claims processing and/or appeals experience

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