Appeals Manager

CGS Administrators, LLC•Nashville, TN

6d•Onsite

About The Position

BlueCross BlueShield of South Carolina is hiring an Appeals Manager for CGS, a subsidiary company. The role manages the 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 the One Century Plaza location in Nashville, Tennessee. It is Monday through Friday, 40–45 hours per week, with flexibility to begin work at 5:00 a.m. or 9:00 a.m. Central Time. The schedule may extend to 45 hours due to special projects and assignments, and 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.
Five years in a leadership position responsible for staff management in a Medicare or similar environment, or equivalent military experience at 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.
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.
Seven years in a leadership position responsible for staff management in a Medicare environment, or equivalent military experience at grade E4 or above, including experience in claims, medical affairs, or provider networks.
Ability to use complex mathematical calculations.
Knowledge of mathematical or statistical concepts.
Knowledge of database software.

Responsibilities

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