Appeals Specialist (Medical Claims)

The role

The Appeals Specialist assists in the operations of the Health and Welfare Claims Department. The role focuses on member disputes and appeals.

What you will do

• Review and process member and provider appeals
• Analyze claims, benefits, contracts and regulations to make appeal decisions
• Collaborate with internal teams to prepare and present appeal cases
• Communicate appeal outcomes to members, providers and representatives
• Provide guidance and support to members and providers on appeal procedures

Required qualifications

• Bachelor’s degree or combination of relevant education and experience
• Interpret and retain detailed information from multiple plan descriptions
• 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

Nice to have

• Medical claims processing and/or appeals experience

Benefits

• Medical, dental (w/orthodontia), vision, Rx benefits, disability & life insurance
• Optional 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)
• Holidays (10 days)
• Work-life balance
• Training and development opportunities

About the company

Northwest Administrators, Inc. is an industry leader in third-party administration of employee benefits. They administer one of the largest multi-employer pension plans in the country and numerous large health and welfare plans.