Claims Specialist

Claims Support SpecialistSpecialty: Healthcare Claims / Managed Care OperationsLocation: Renton, WashingtonEmployment Type: Contract to HireShift: 5 x 8 Hours, DaysStart Date: 11/16/2026Position OverviewNuWest is seeking a detail-oriented Claims Support Specialist for a contract-to-hire opportunity with a healthcare operations team in Renton, Washington. This role adjudicates medical claims, processes adjustments, and researches claim discrepancies to ensure accurate payments in line with plan benefits, provider contracts, and regulatory requirements. The ideal candidate is highly organized, analytical, and thrives in a fast-paced environment while managing a high volume of work with accuracy.Key ResponsibilitiesReview, analyze, and adjudicate medical claims for accuracy and compliance with plan benefits, contracts, and reimbursement methodologiesVerify benefit eligibility, authorization requirements, fee schedules, and provider contracts to determine appropriate paymentProcess claim adjustments, corrections, and complex manual calculationsResearch and resolve unclear, unusual, or problematic claims, including monitoring activity reports and reprocessing pended claimsIdentify and escalate compliance concerns or processing issues to managementCommunicate with providers, vendors, and members regarding claim status and payment determinationsCollaborate with operations, customer service, finance, utilization management, and IT teamsIdentify trends, system issues, and training opportunities to support process improvementRequired QualificationsHigh school diploma or GED (equivalent healthcare business administration experience may be considered)Minimum 2 years of experience in managed care operationsAt least 1 year of healthcare claims processing experience in a TPA, MSO, HMO, PHO, health plan, or large medical group settingExperience with specialty claim areas such as coordination of benefits (COB), claim adjustments, point-of-service claims, home health, or encountersWorking knowledge of healthcare claims systems and medical coding (CPT, ICD, HCPCS)Ability to pass required background check and drug screening