Appeals Specialist - (CGS Admin)
About The Position
This position is within CGS Administrators, a subsidiary company of BlueCross BlueShield of South Carolina. CGS has been a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members, Medicare beneficiaries, healthcare providers, and medical equipment suppliers for more than 50 years. The Appeals Specialist performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy. They also prepare unit reports, analyze and interpret workload, and process issues utilizing various software tools. Additionally, they update letters and documents within the department when necessary and may gather and prepare documentation for legal inquiries and administrative requests.
Requirements
- High School Diploma or equivalent
- 2 years job related field.
- Demonstrated proficiency in word processing and spreadsheet software.
- Excellent organizational, customer service, and written and verbal communication skills.
- Good judgment skills.
- Proficiency in spelling, punctuation, and grammar skills.
- Microsoft Office.
Nice To Haves
- Experience in medical claims processing, appeals, or coding strongly preferred
- Medicare Part B experience preferred
- Strong computer proficiency, with the ability to navigate multiple systems and work across dual screens efficiently
- Intermediate-level Excel skills
- Experience creating letters and documents by reviewing appeals and extracting information with a high degree of accuracy; updates departmental documents as needed.
Responsibilities
- Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.
- Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools.
- Updates letter's and documents within the department when necessary.
- May gather and prepare documentation for legal inquiries and administrative requests.
Benefits
- Subsidized health plans, dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
