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Appeals Associate Jobs in Missouri (NOW HIRING)

Von Maur

SALES ASSOCIATE

Lake Saint Louis, MO · On-site

$13.25 - $18/hr

As a Sales Associate , you represent Von Maur and impact our reputation as America's Leading ... Maintain a visually appealing and clean department * Achieve individual sales and account goals

CPR Cell Phone Repair (formerly known as Wireless Trendz)

Be Seen First

Sales Associate

Springfield, MO · On-site

$15 - $18/hr

As a Sales Associate, you will engage customers with the latest smartphones, tablets, gaming ... Maintain a clean and appealing store appearance * Resolve customer issues professionally and ...

Von Maur

SALES ASSOCIATE - COSMETICS

Lake Saint Louis, MO · On-site

$13.25 - $18/hr

As a Cosmetic Sales Associate , you represent Von Maur and impact our reputation as America ... Maintain a visually appealing and clean department * Be available to work day, evening, and weekend ...

Von Maur

PART TIME SALES ASSOCIATE

Lake Saint Louis, MO · On-site

$13.25 - $18/hr

As a Sales Associate , you represent Von Maur and impact our reputation as America's Leading ... Maintain a visually appealing and clean department * Achieve individual sales and account goals

BoxLunch & Hot Topic

Sales Associate

Springfield, MO · On-site

$12.75 - $17.25/hr

We're on the search for a Sales Associate that will help lead our civic minded, pop culture driven ... appealing way, all while being hyper-focused on the in-store experience. WHAT YOU'LL DO * Provide ...

BoxLunch & Hot Topic

Sales Associate

Branson, MO · On-site

$12.50 - $16.75/hr

We're on the search for a Sales Associate that will help lead our civic minded, pop culture driven ... appealing way, all while being hyper-focused on the in-store experience. WHAT YOU'LL DO * Provide ...

BoxLunch & Hot Topic

Sales Associate

Saint Louis, MO · On-site

$13.50 - $18.50/hr

We're on the search for a Sales Associate that will help lead our civic minded, pop culture driven ... appealing way, all while being hyper-focused on the in-store experience. WHAT YOU'LL DO * Provide ...

BoxLunch & Hot Topic

Sales Associate

Saint Peters, MO · On-site

$13.50 - $18.25/hr

We're on the search for a Sales Associate that will help lead our civic minded, pop culture driven ... appealing way, all while being hyper-focused on the in-store experience. WHAT YOU'LL DO * Provide ...

Cassiday Schade LLP

Associate Attorney

Saint Louis, MO · On-site

Cassiday Schade LLP is actively seeking an Associate Attorney for its St. Louis, MO office with ... In addition to trial and appellate work, we provide both organizations and individuals with the ...

PALM Health

Facility & Environment Associate

Saint Louis, MO · On-site

$16 - $21.50/hr

This includes maintaining fully stocked, orderly, and visually appealing spaces that support a seamless and elevated member experience. Requirements: The Facility & Environment Associate performs ...

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Appeals Associate information

What are the key skills and qualifications needed to thrive as an appeals associate?

To thrive as an Appeals Associate, you need strong analytical abilities, attention to detail, and a solid understanding of claims processing or legal documentation, often supported by a degree in a related field. Familiarity with case management systems, claims processing software, and regulatory compliance tools is typically required. Excellent written communication, organization, and problem-solving skills are essential soft skills for effectively managing appeals and collaborating with stakeholders. These competencies ensure accurate resolution of appeals, compliance with regulations, and efficient workflow within the organization.

What are some common challenges appeals associates face when reviewing complex cases, and how can they be addressed?

Appeals Associates often encounter cases with incomplete documentation or ambiguous information, which can make it challenging to reach timely and accurate decisions. To address this, they must communicate effectively with internal teams and external parties to gather missing details and clarify uncertainties. Staying up-to-date with changing regulations and organizational policies is also crucial, as appeals often involve nuanced compliance requirements. Collaboration and continuous learning are key to overcoming these challenges and ensuring fair outcomes.

What is the difference between Appeals Associate vs Claims Processor?

CriteriaAppeals AssociateClaims Processor
Required CredentialsHigh school diploma or equivalent; sometimes an associate degree; knowledge of insurance policiesHigh school diploma or equivalent; familiarity with claims processing systems
Work EnvironmentOffice setting, often in insurance or healthcare companiesOffice or remote, handling claims in insurance or healthcare sectors
Employer & Industry UsageInsurance companies, healthcare providers, government agenciesInsurance companies, healthcare organizations, third-party administrators
Common Search & Comparison IntentUnderstanding roles in appeals and claims processesDifferences in claims handling and processing tasks

Appeals Associates focus on reviewing and resolving denied claims or appeals, requiring knowledge of policies and customer communication. Claims Processors handle the initial processing of claims, verifying information and entering data. Both roles are vital in insurance and healthcare industries but differ in their specific responsibilities and stages of claims management.

What does an appeals associate do?

An appeals associate reviews and processes appeals related to denied claims, benefits, or decisions within an organization. They analyze case details, gather supporting documentation, and communicate with clients or stakeholders to resolve disputes efficiently, often using specialized case management systems. Strong attention to detail and knowledge of relevant policies are essential for this role.

What are the most commonly searched types of Appeals jobs in Missouri?

The most popular types of Appeals jobs in Missouri are:

What cities in Missouri are hiring for Appeals Associate jobs?

Cities in Missouri with the most Appeals Associate job openings:

Appeals Associate jobs near you

Grievance/Appeals Analyst I (US)

Saint Louis, MO

Elevance Health
Health Care and Social Assistance • 10K+ employees

7.6

Company rating: 7.6 out of 10

Based on 352 frontline employees who took The Breakroom Quiz

212th of 311 rated insurance

People enjoy working here

Good employer

Recommended by students

Learn more about Elevance Healthexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 7 days ago

Job description

Grievance/Appeals Analyst I

Shift: Tuesday-Saturday
Location: Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.
The Grievance/Appeals Analyst I will be this is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple products (i.e. HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of service, and quality of care issues to include executive and regulatory grievances.
How you will make an impact:

  • Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language

  • Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to nursing and/or medical staff for review

  • The grievance and appeal work is subject to applicable accreditation and regulatory standards and requirements As such, the analyst will strictly follow department guidelines and tools to conduct their reviews

  • The file review components of the URAC and NCQA accreditations are must pass items to achieve the accreditation

  • Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination

  • Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information

  • The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and other internal departments


Minimum Requirements:

  • Requires a HS diploma or GED and a minimum of 3 years experience working in grievances and appeals, claims, or customer service; or any combination of education and experience which would provide an equivalent background.


Preferred Skills, Capabilities, and Experiences:

  • Demonstrated business writing proficiency, understanding of provider networks, the medical management process, claims process, the company's internal business processes, and internal local technology is strongly preferred

  • For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

Social media

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Benefits

Hours and flexibility

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