Medical Claims Auditor (Hybrid)
About the position Are you a skilled communicator with strong writing abilities and deep, hands-on experience processing medical claims? Do you enjoy applying your claims expertise to work one-on-one, or in small group settings, to help others strengthen their accuracy, compliance, and performance? If so, you may be the ideal candidate for our Claims Auditor position within our Health & Welfare group. What you'll be doing... As a Health and Welfare Claims Auditor, the main focus will be to review the work completed by the Health and Welfare Medical, Dental, Vision, Time Loss and Life Claims Processors. This position requires collaboration with other auditors, outside vendors, account executives, department supervisors and managers, and medical consultants. Primary responsibilities for this position include: Perform internal audits of our Health and Welfare Claims Processors' work Design and implement training plans for Claims Processors Conduct training sessions for groups of new Claims Processors Train and cross-train on plan, system and procedural changes Respond to day-to-day referral questions Perform random and large dollar claims audits Prepare written claim processing guideline materials Coordinate vendor interaction with specific PPOs and benefit providers This position has a hybrid work schedule with 3 days per week in the office, after completion of training. The position can be based in our Seattle, Mountlake Terrace or Federal Way office. Who you are... Educated. Bachelor's degree preferred or equivalent combination of education & experience Experienced. Medical & Dental Claims processing; auditing/training experience preferred Organized. Able to prioritize work, multi-task and work independently Communicator. Excellent verbal, written and interpersonal communication skills Technically Savvy. Intermediate level experience using Microsoft Office Suite of tools 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 upon 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 employer base contribution and match Paid Vacation (10 days), Sick Leave (10 days) and Holidays (10 days) Collaborative team environment 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)
Responsibilities
- Perform internal audits of our Health and Welfare Claims Processors' work
- Design and implement training plans for Claims Processors
- Conduct training sessions for groups of new Claims Processors
- Train and cross-train on plan, system and procedural changes
- Respond to day-to-day referral questions
- Perform random and large dollar claims audits
- Prepare written claim processing guideline materials
- Coordinate vendor interaction with specific PPOs and benefit providers Requirements
- Bachelor's degree preferred or equivalent combination of education & experience
- Medical & Dental Claims processing
- Excellent verbal, written and interpersonal communication skills
- Intermediate level experience using Microsoft Office Suite of tools
- Able to prioritize work, multi-task and work independently Nice-to-haves
- auditing/training experience preferred Benefits
- 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 employer base contribution and match
- Paid Vacation (10 days), Sick Lea
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