Appeals Manager

BlueCross BlueShield of South Carolina•Nashville, TN

3d•Onsite

About The Position

BlueCross BlueShield of South Carolina is hiring an Appeals Manager for CGS, a subsidiary company. The role manages successful operations of a department responsible for administering part of a Medicare service contract. Functional areas may include quality independent contractor (QIC), administration, appeals, systems, or records. The position is onsite at One Century Plaza in Nashville, Tennessee, and is scheduled for 40–45 hours per week, Monday through Friday, with flexibility to begin between 5:00 a.m. and 9:00 a.m. Central Time. Occasional overtime may be necessary based on business needs. The position requires the ability to obtain a security clearance, which requires U.S. citizenship.

Requirements

Bachelor's degree.
At least 5 years in a leadership position responsible for staff management in Medicare or a similar environment, or equivalent military experience in grade E4 or above.
Excellent verbal and written communication skills.
Excellent judgment, organizational, customer service, and analytical/critical thinking skills.
Proficiency in grammar, spelling, and punctuation.
Basic business math proficiency.
Ability to handle confidential or sensitive information with discretion.
Working knowledge of word processing and spreadsheet software.
Microsoft Office proficiency.
Ability to obtain a security clearance; applicants must be U.S. citizens.

Nice To Haves

Bachelor's degree in Business Administration, Business Management, Healthcare Administration, or a related field.
7 years in a leadership position responsible for staff management in a Medicare environment, or equivalent military experience in grade E4 or above; experience also including claims, medical affairs, or provider network experience.
Ability to use complex mathematical calculations.
Knowledge of mathematical or statistical concepts.
Knowledge of database software.

Responsibilities

Provides management oversight of departmental staff and programs.
Ensures compliance with Center for Medicare and Medicaid Services (CMS) guidelines and performance standards.
Collaborates with other functional areas to resolve multifunctional issues.
Participates in special projects as assigned.