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Insurance Appeals Jobs in Iowa (NOW HIRING)

Trinityhealth

Case Manager RN

Des Moines, IA · On-site

Review and route denial notifications for appeal consideration; collaborate with post-denials, RAC, and appeal teams. * Monitor insurance coverage and communicate updates to verification and ...

Trinity Health

Case Manager RN

Des Moines, IA · On-site

Review and route denial notifications for appeal consideration; collaborate with post-denials, RAC, and appeal teams. * Monitor insurance coverage and communicate updates to verification and ...

Trinity Health

Case Manager RN Days

Des Moines, IA · On-site

Review and route denial notifications for appeal consideration; collaborate with post-denials, RAC, and appeal teams. * Monitor insurance coverage and communicate updates to verification and ...

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Insurance Appeals information

What are insurance appeals?

Insurance appeals are formal requests made to an insurance company to reconsider and potentially overturn a denied claim or coverage decision. When an insurance provider refuses to pay for a service or treatment, policyholders or healthcare providers can submit an appeal with supporting documentation to argue why the claim should be approved. The appeals process typically involves several steps and may require detailed medical records, letters from healthcare professionals, and a clear explanation of why the original decision should be reversed.

What are the key skills and qualifications needed to thrive in insurance appeals?

To thrive in Insurance Appeals, you need a solid understanding of insurance policies, claims processes, medical terminology, and relevant regulations, often supported by experience in healthcare administration or a related field. Familiarity with claims management software, electronic health records (EHRs), and knowledge of HIPAA compliance are typically required. Strong analytical skills, attention to detail, and effective written and verbal communication set outstanding professionals apart. These skills are crucial for efficiently navigating complex appeals, ensuring compliance, and achieving positive outcomes for clients or organizations.

What are some common challenges faced in an insurance appeals role, and how can they be managed?

Professionals in Insurance Appeals often encounter challenges such as navigating complex policy guidelines, handling tight deadlines, and managing extensive documentation requirements. Staying organized and up-to-date on insurance regulations is essential to ensure accurate and timely submissions. Collaborating closely with medical providers, patients, and insurance representatives can help clarify information and strengthen appeal cases. Effective time management and clear communication are key to overcoming these challenges and achieving successful outcomes.

What are popular job titles related to Insurance Appeals jobs in Iowa?

For Insurance Appeals jobs in Iowa, the most frequently searched job titles are:

What job categories do people searching Insurance Appeals jobs in Iowa look for?

The top searched job categories for Insurance Appeals jobs in Iowa are:

What cities in Iowa are hiring for Insurance Appeals jobs?

Cities in Iowa with the most Insurance Appeals job openings:

Insurance Appeals jobs near you
Infographic showing various Insurance Appeals job openings in Iowa as of August 2026, with employment types broken down into 2% As Needed, 73% Full Time, 21% Part Time, and 4% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution.

Case Manager RN

Trinityhealth

Des Moines, IA • On-site

Full-time

Re-posted 13 days ago

Job description

Employment Type:Full timeShift:Description:RN Case Manager (Onsite)

Shift:

Monday-Friday (8 hours) No Weekends

General Summary:

Responsible for the review of inpatient and outpatient admission records for appropriate admission status at Mercy Medical Center and Mercy West Lakes. Works in collaboration with the attending physician and the Case Management staff utilizing admission criteria guidelines-and second level physician review process when appropriate. Interacts with insurance providers to obtain authorization and continued stay approval for admission. Collaborates with the Verification department, Revenue cycle and Medical Eligibility to facilitate the establishment of the correct payer source for patient stay and the documentation of the interactions in the STAR admitting system

Key Responsibilities

  • Perform admission, concurrent, and post-discharge utilization reviews in accordance with the Utilization Management Plan and regulatory requirements.

  • Apply Milliman Care Guidelines and payer-specific criteria to determine appropriate patient status.

  • Collaborate with attending physicians to clarify admission status and initiate second-level physician reviews as needed.

  • Communicate status changes promptly to Case Management, Admitting, and other relevant departments.

  • Provide patient/family education and issue Notices of Status Change when required.

  • Accurately document utilization review activities, status determinations, authorizations, denials, and communications in the medical record and STAR system.

  • Submit timely clinical information to payers to prevent technical denials and support authorization and continued stay.

  • Review and route denial notifications for appeal consideration; collaborate with post-denials, RAC, and appeal teams.

  • Monitor insurance coverage and communicate updates to verification and financial teams.

  • Participate in peer-to-peer reviews and advocate for appropriate admission status and continued stay.

Qualifications

  • Current Iowa RN license.

  • Minimum of five (5) years of clinical nursing experience.

  • BSN or healthcare-related degree preferred.

  • Knowledge of insurance eligibility, CMS rules, and utilization review processes across the continuum of care.

  • Strong clinical judgment, communication, and independent decision-making skills.

  • Utilization Review certification within 12 months of hire preferred.

  • Completion of Mandatory Reporter abuse training within three (3) months of hire.

Work Environment & Physical Requirements

  • Primarily office-based with computer, phone, and documentation tasks.

  • Light physical activity with occasional lifting; use of assistive devices and additional personnel as required.

  • Visual acuity sufficient to review medical records and electronic systems.

  • Ability to work collaboratively in a fast-paced, high-stress healthcare environment while maintaining professionalism and courtesy.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

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