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Appeals Associate Jobs (NOW HIRING)

Bayhealth

Denials And Appeals Specialist

Dover, DE · On-site

... appealing denied claims. The Specialist must effectively interact with multiple disciplines ... Associate Degree High School Diploma or GED ; or four years of patient accounting experience.

Bayhealth

Denials And Appeals Specialist

Dover, DE · On-site

... appealing denied claims. The Specialist must effectively interact with multiple disciplines ... Associate Degree High School Diploma or GED ; or four years of patient accounting experience.

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$46K

$108.2K

$172.5K

How much do appeals associate jobs pay per year?

As of Jun 6, 2026, the average yearly pay for appeals associate in the United States is $108,160.00, according to ZipRecruiter salary data. Most workers in this role earn between $80,000.00 and $130,000.00 per year, depending on experience, location, and employer.

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 does an Appeals Associate do?

An Appeals Associate is responsible for reviewing, analyzing, and processing appeals related to denied claims or decisions, often within insurance, legal, or healthcare settings. They assess documentation, gather relevant information, and communicate with clients or stakeholders to resolve disputes or overturn decisions. Appeals Associates ensure compliance with company policies and regulatory guidelines while managing deadlines and maintaining accurate records. Their role is crucial in ensuring fair outcomes and upholding the integrity of decision-making processes.

What are the key skills and qualifications needed to thrive as an Appeals Associate, and why are they important?

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 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.

More about Appeals Associate jobs
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Appeals Associate jobs near you
Infographic showing various Appeals Associate job openings in the United States as of May 2026, with employment types broken down into 33% As Needed, and 67% Full Time. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $108,160 per year, or $52 per hour.
Appeals Professional III (Weekend Work)

Appeals Professional III (Weekend Work)

TMF Health Quality Institute

Austin, TX • On-site, Remote

$98K - $116K/yr

Full-time

Medical, Retirement

Posted 8 days ago

Job description

*This position is working weekends - includes both Saturday and Sunday*
*This is a part-time position*
**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**
*This position is located Remote United States*
Position Purpose:
Provides an independent second level determination based on the documentation, facts, laws, regulations, and guidelines.
Essential Responsibilities:
  • Reviews medical records/case file, writes a reconsideration decision letter that is clear, concise, and impartial and supports the determination made, and documents review.
  • Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation, rulings, and policy.
  • Responds to and ensures that all appeal issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.
  • Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures.
  • Conducts research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to complete an accurate and well-supported decision.

Minimum Qualifications
Education
  • Associate's degree or 60 or more credit hours towards a Bachelor's degree from an accredited college or university in healthcare or related discipline
    • Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for Associate's degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)

Experience
  • Three (3) years of medical dispute resolution or Medicare appeals, medical review, clinical, or related experience in a healthcare setting
  • Healthcare Professional with Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience
  • Demonstrated experience writing or making medical necessity decisions
  • Prior experience working on the Part C Qualified Independent Contractor (QIC) effort
  • Experience directly relevant to Medicare managed care appeals or utilization management activities, preferred
  • Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)

Benefits
C2C offers an excellent benefits package, including:
  • 401K
  • Competitive salary
  • License/credentials reimbursement
  • Tuition Reimbursement

EOE Vet/Disability
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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